CCSD code F2660 – Tongue flap billing and coding guide

Key takeaways

CCSD Code F2660 covers a tongue flap under one code, including the first stage (flap elevation) and the second stage (pedicle division and inset).

Both stages are usually performed under general anaesthesia, roughly 2 to 4 weeks apart, and each one needs its own operative note.

Most insurers expect pre-authorisation before the first stage, so confirm the requirement for each insurer and policy.

CCSD lists F2210, F2220, F2222 and F2650 as unacceptable combinations with F2660.

Pabau, the practice management platform we build, keeps operative notes, consent forms and insurer references on one patient record across both stages.

What is CCSD Code F2660?

CCSD Code F2660 is the UK private healthcare procedure code for a tongue flap, covering both its first and second stage. It sits in Chapter 6 of the CCSD schedule, “Face, mouth, salivary and thyroid”, under sub-chapter 6.3.0 Tongue. UK private medical insurers (PMIs), including Bupa, AXA Health, Aviva and WPA, use the schedule to process surgical claims from recognised consultants.

The Clinical Coding and Schedule Development (CCSD) group maintains the schedule. Our guide to CCSD codes explains how its chapters are organised and how insurers apply them.

The official CCSD descriptor is: Tongue flap – first stage and second stage. That descriptor is the reference point for billing. Insurers will typically query or reject a claim that mislabels the procedure or bills one stage without documenting the staging intent. The same goes for a claim that quotes an NHS OPCS-4 code in place of the CCSD code.

CCSD codes are distinct from NHS coding. NHS trusts use OPCS-4 to classify the same surgical interventions for activity reporting. F2660 is used only in private practice billing. Confusing the two systems is a material coding error that can delay payment or trigger a compliance review.

Procedure overview: tongue flap first stage and second stage

A tongue flap is a pedicle flap. A segment of tongue mucosa and underlying tissue stays attached by a vascular pedicle. It’s rotated or transposed to cover a nearby intraoral defect. Because the flap stays attached during healing, the procedure is staged by design.

First stage: flap elevation

The surgeon designs and elevates a portion of the tongue, typically from the dorsal or lateral surface. It’s sutured to the recipient site, which may be a palatal defect, a floor of mouth wound or other intraoral tissue loss. The pedicle remains intact, supplying blood to the transferred tissue while it integrates. This stage is performed under general anaesthesia.

Second stage: pedicle division and inset

After approximately 2 to 4 weeks, once the transferred tissue has developed an adequate blood supply, the surgeon divides the pedicle. The inset is then refined at both the donor and recipient sites. This second procedure also requires general anaesthesia and is a discrete surgical event with its own operative note.

The interval between the two operations shapes the billing. Each stage is its own clinical encounter, with its own anaesthetic and its own operative note. F2660 is still one code covering both stages. Whether you submit one claim or two, and how the fee is split, depends on the insurer’s rules. Confirm both with the insurer before the first stage.

Clinical indications: when is a tongue flap performed?

Oral and maxillofacial surgeons use tongue flaps when no simpler local tissue can close an intraoral defect. They’re also chosen when a free flap would be disproportionate to the size of the defect. Common indications include:

• Palatal fistula repair: post-cleft or post-resection palatal defects where palatal mucosa alone cannot provide closure
• Floor of mouth reconstruction: following tumour excision or trauma when primary closure would restrict tongue movement
• Retromolar or tonsillar defects: post-oncological resection defects in the posterior oral cavity
• Alveolar defects: bony alveolar reconstruction where soft-tissue coverage is needed before grafting
• Oro-nasal fistula repair: select cases where palatal tissue has been lost and tongue tissue offers the most accessible vascularised cover

Coders should confirm the indication from the operative note and include the matching ICD-10 diagnosis code on the claim. The indications above span several ICD-10 chapters. The right code depends on the underlying pathology the surgeon documents, whether congenital, traumatic or oncological.

What F2660 includes and excludes

Knowing what sits inside the code prevents unbundling errors and cuts down on insurer queries. The last column lists the codes CCSD marks as unacceptable combinations with F2660.

Anaesthetic fees are always billed independently by the anaesthetist, using their own CCSD or agreed fee schedule. Including them in the surgical claim is a bundling error that the insurer’s audit team will challenge. Other work at the same sitting may need its own code, such as a free flap, a donor-site graft or bone grafting. Check the CCSD schedule before billing it alongside F2660. The CCSD technical guide sets out the current rules on concurrent procedures and anaesthetic supplements for staged cases.

Billing F2660: how to use the code correctly

Tongue flap billing under F2660 follows the general CCSD workflow, but the two operations add steps that single-episode codes don’t need. For teams handling CCSD billing with Bupa and other UK insurers, the staged workflow runs as follows:

1. Obtain pre-authorisation before the first stage. Contact the patient’s insurer with the procedure code (F2660), the treating consultant’s details, and the planned hospital or surgical facility. Most UK PMIs expect written pre-authorisation before an inpatient procedure.
2. Submit the first-stage documentation within the insurer’s deadline. Claim deadlines vary by insurer and policy, so check each insurer’s current terms. Include the stage one operative note, the anaesthetic claim reference if known, and the relevant ICD-10 diagnosis code.
3. Notify the insurer of the planned second stage. Some insurers require a second pre-authorisation or a progress letter confirming clinical readiness for stage two. Check the patient’s policy terms.
4. Send the second-stage documentation with its own operative note. Depending on the insurer, this goes on a second claim or completes a single claim for the episode. Include the date of the second procedure, the stage identifier, and any consultant letter confirming pedicle division.
5. Reconcile payment against the agreed fee schedule. The F2660 fee covers both stages. Confirm with the insurer whether it’s split between submissions or paid in full once the episode is complete.

The flow below shows where each of those checks falls across the two operations, and which codes stay off the claim.

Adjacent CCSD codes to know

The codes closest to F2660 sit in the same sub-chapter, 6.3.0 Tongue. CCSD lists all four below as unacceptable combinations with F2660, so none of them should be billed alongside it.

CCSD’s coding principles are guidelines, and each insurer decides whether to adopt a given combination rule. Check the current CCSD schedule and the insurer’s own rules before billing, as codes can change in tariff updates. Flap repairs elsewhere in the mouth carry their own codes, such as F0420 for lip reconstruction with a skin flap.

Documentation requirements for F2660 claims

Insurers reviewing tongue flap claims look for five core documentation elements. Missing any one of them is enough to trigger a query or rejection. In Pabau, all five can sit together on the patient’s record, so neither stage goes out with a document missing.

• Operative note for each stage: must describe the flap design, dimensions, recipient site, technique used, and any complications. A generic “tongue flap performed” note is insufficient.
• ICD-10 diagnosis code: the primary diagnosis (e.g. palatal fistula, floor of mouth defect) must appear on the claim. The diagnosis code must align with the surgical indication described in the operative note.
• Pre-authorisation reference number: quote the insurer’s approval reference on every stage-one and stage-two submission. A claim without a valid reference is likely to be stopped before clinical review.
• Procedure date and stage identifier: clearly label each submission as “stage 1” or “stage 2” with the corresponding date. Where the insurer’s claim form has no staging field, add this in a free-text notes section or covering letter.
• Consultant details: the claim must match the name and recognition number of the consultant who performed the procedure. If a trainee assisted under supervision, note that in the operative record but bill under the consultant’s name.

Pre-authorisation requirements

Pre-authorisation requirements vary by insurer and by policy type. Most insurers expect it before surgery, so confirm the rules for each insurer and policy. As a general guide for the major UK PMIs that recognise CCSD coding:

• Bupa: pre-authorisation is expected for inpatient and day-case surgical procedures. Submit via the Bupa provider portal with the F2660 code, consultant recognition number, and proposed hospital. Confirm whether both stages are covered under a single authorisation or whether a second request is needed before stage two.
• AXA Health: pre-authorisation is expected for most surgical procedures. AXA issues a separate authorisation reference per episode, so ask whether a staged procedure generates one reference or two.
• Aviva: refer to the Aviva fee schedule for procedure-level pre-authorisation requirements. Aviva’s online provider portal lets you check coverage status before booking.
• WPA: confirm pre-authorisation requirements via the WPA provider information hub. WPA policies vary significantly by employer group, so always verify against the patient’s specific policy.
• Vitality and others: requirements differ by plan tier. Obtain written confirmation rather than relying on verbal approval.

If a patient proceeds to surgery without pre-authorisation, the insurer may decline to pay or reduce payment significantly. That liability falls on the practice, not the patient, if the requirement was not communicated clearly before treatment began.

Common claim denial reasons and how to avoid them

Tongue flap billing runs across two operations several weeks apart, which gives the insurer two points at which to query the episode. The table below covers the most frequent denial triggers and the corrective action for each.

How Pabau keeps a staged F2660 claim on track

For oral and maxillofacial surgery (OMFS) practices, the hard part of F2660 is holding one episode together across two operations. Pabau’s claims management software sends claims to Healthcode and tracks their status. Both stages’ documents sit on the same patient record, so the billing team works from one file.

1. Open the patient record. Note the procedure (tongue flap, F2660) and that it runs in two stages. The billing team then has one reference point across both surgical visits.
2. Attach the pre-authorisation. As soon as the insurer issues the reference, upload the written approval alongside it. It’s then to hand at every submission point.
3. Record the first stage. After stage one, upload the operative note and label it “stage 1”. Confirm the ICD-10 diagnosis code is recorded.
4. Set a follow-up task for the second stage. Stage two usually follows 2 to 4 weeks after stage one. Reminders at day 14 and day 28 keep the insurer’s claim deadline in view.
5. Record the second stage and submit. After pedicle division, upload the second operative note and confirm the stage identifier. Then send it with the same pre-authorisation reference, following the insurer’s rules for staged claims.

Pabau’s digital consent forms also capture the patient’s consent for each stage electronically. That gives you an audit-ready record if an insurer asks for documentation during a later review.

Manage staged surgical claims in one place

Pabau keeps operative notes, consent forms and insurer references on one patient record, so your team always knows where a staged claim stands.

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Conclusion

F2660 is simple to code and easy to lose track of. The code covers both operations, but the insurer decides how the episode is authorised, claimed and paid. Those rules differ from one PMI to the next.

So settle the questions before the first stage, not after the second. Ask whether one authorisation covers both stages, whether the insurer wants one claim or two, and what its claim deadline is. Then keep both operative notes and the approval on the same record, and keep F2210, F2220, F2222 and F2650 off the claim.

Book a demo to see how Pabau keeps both stages of a tongue flap claim on one patient record, from pre-authorisation to payment.

Continue your research

Need a complete guide to CCSD billing with Bupa? Bupa CCSD codes and billing guide covers code lookup, insurer submission requirements, and fee schedule navigation for UK private practice.

Want to see how the CCSD schedule fits together? CCSD codes explained walks through the chapters, code structure and how UK private insurers use the schedule.

Billing another flap repair in the mouth region? CCSD code F0420: lip reconstruction using a skin flap covers the documentation and claim steps for flap reconstruction of the lip.

Coding a palatal repair instead of a tongue flap? CCSD code F3070: suture of palate explains when a palatal suture is billed and what insurers expect to see.

Repairing a lip wound as a sole procedure? CCSD code F0530: suture of lip sets out the billing rules for a standalone lip suture in Chapter 6.

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