CCSD code G2400 – Transthoracic fundoplication and gastroplasty

Key takeaways

CCSD code G2400 covers transthoracic fundoplication combined with gastroplasty as one bundled procedure. The open thoracic approach separates it from laparoscopic codes such as G2331.

The operative note must document both components. Confirm the thoracotomy, the wrap technique (Nissen, Toupet or Belsey) and the Collis gastroplasty that lengthens the oesophagus.

Missing gastroplasty documentation and the wrong approach code are the two most frequent denial triggers for G2400 claims with UK private payers.

Pabau, the practice management platform we build, gives surgical practices structured operative forms and claims tools that capture the detail G2400 claims require.

What is CCSD code G2400?

CCSD code G2400 is the Clinical Coding and Schedule Development (CCSD) code for transthoracic fundoplication and gastroplasty. It is billed as a single combined procedure in UK private healthcare. The code sits in the G section of the CCSD schedule, which covers upper gastrointestinal surgical procedures.

CCSD files G2400 under chapter 8.1.0 Oesophagus, with schedule reference Fh.010, and our CCSD code library lists the codes around it. Unlike laparoscopic anti-reflux procedures, G2400 requires an open transthoracic approach, typically a left posterolateral thoracotomy. It is the correct code only when the chest has been entered.

The two components of G2400 are inseparable for billing purposes. Transthoracic fundoplication wraps the gastric fundus around the lower oesophagus to reinforce the lower oesophageal sphincter (LOS) and prevent acid reflux.

Gastroplasty, most commonly a Collis gastroplasty, lengthens a short or strictured oesophagus by creating a neoesophagus from the gastric cardia before the wrap is applied. Both steps must be performed to justify CCSD code G2400. A fundoplication without a gastroplasty component needs a different code.

The procedure: Transthoracic fundoplication and gastroplasty explained

Transthoracic fundoplication is an open anti-reflux operation performed through a thoracotomy incision, most often a left posterolateral approach. The surgeon reaches the distal oesophagus and gastro-oesophageal junction (GOJ) through the chest cavity rather than the abdomen. That route separates it from laparoscopic or open transabdominal fundoplication, and it is what points the claim to CCSD code G2400.

The gastroplasty component addresses a short oesophagus. When gastro-oesophageal reflux disease (GORD) has caused fibrosis and oesophageal shortening, a standard wrap placed under tension will fail and herniate back into the chest.

Collis gastroplasty resolves this by creating a tubular extension of the oesophagus from the gastric cardia, lengthening the food pipe before the wrap is applied. The combined G2400 procedure therefore treats two problems in a single operative session.

Named techniques billed under G2400

• Belsey Mark IV (with Collis gastroplasty): A 270-degree partial anterior fundoplication performed via left thoracotomy, the archetypal transthoracic technique. The partial wrap carries less dysphagia risk than a total 360-degree wrap. It is billed under G2400 only with a Collis gastroplasty, because a Belsey wrap alone does not meet G2400.
• Collis-Nissen: Collis gastroplasty to lengthen the oesophagus, followed by a 360-degree Nissen fundoplication wrap. Preferred when a tension-free total wrap can be achieved after lengthening.
• Collis-Belsey: Collis gastroplasty combined with a Belsey partial wrap. Selected when the total wrap would cause unacceptable dysphagia or where motility is impaired.
• Collis-Toupet: Collis gastroplasty with a 270-degree posterior Toupet wrap. Less common but within the scope of G2400 when performed via thoracotomy with a gastroplasty component.

Clinical indications: When is G2400 performed?

G2400 is a specialist anti-reflux procedure for cases where laparoscopic fundoplication has failed or is unsuitable, or where the transthoracic route offers a clear advantage. The indications matter to billers because the operative note must link the approach to a documented clinical reason. Insurers may scrutinize whether the thoracic route was justified.

• Failed previous anti-reflux surgery: Reoperative cases where a prior laparoscopic Nissen has slipped, herniated, or caused intractable dysphagia. The thoracic approach gives better access than a hostile abdominal field.
• Confirmed short oesophagus: Where pre-operative manometry and barium swallow, or intra-operative assessment, confirm oesophageal shortening that cannot be corrected without gastroplasty.
• Complex or giant para-oesophageal hiatal hernia: Large hernias with an intrathoracic stomach where the transthoracic route provides better exposure for reduction and repair alongside fundoplication.
• Oesophageal stricture secondary to reflux: Peptic stricture with associated shortening where gastroplasty is required before any wrap can be placed.
• Concurrent thoracic pathology: A thoracotomy is already indicated for another reason, such as a paraoesophageal hernia with pleural involvement. The anti-reflux procedure is then combined in the same session.
• Severe obesity with prior abdominal surgery: Where abdominal adhesions or obesity make laparoscopic access technically unsafe and a transthoracic approach offers better visualization.

Coders should note that GORD alone, without one of the above complicating factors, is not typically sufficient to justify a transthoracic approach. The operative note and pre-operative documentation should explicitly record the clinical rationale. UK private payers including Bupa and AXA Health may request clinical notes to confirm medical necessity, particularly for reoperation cases.

G2400 vs neighboring CCSD codes: What is included and what is not

Two facts settle the code: The surgical approach, and whether a gastroplasty was performed. When the operation stays in the abdomen, the claim moves away from G2400. Laparoscopic hiatus hernia repair with an anti-reflux wrap is G2331, and transabdominal hiatus hernia repair is G2330.

The decision path below shows how those two questions route a claim. For the wider schedule, the Bupa CCSD codes guide covers fee-schedule structure and code lookup.

The table compares G2400 with the codes it is most often confused with.

*Check the current CCSD schedule for the code that covers a transthoracic wrap without a gastroplasty. CCSD codes are revised periodically, so confirm G2400 is current in the latest edition before you submit a claim.

Is hiatal hernia repair billable alongside G2400?

Usually not. Most CCSD payer schedules treat a hiatal hernia repair that prepares the field for the wrap as part of G2400. They will not reimburse it separately. The answer is still payer-specific, so don’t assume a blanket yes or no.

Some payers will consider a separate code alongside G2400 when the hernia repair is a substantial, clinically distinct procedure. That means a significantly enlarged or complicated hernia that needed surgical attention beyond standard crural dissection.

To support a dual-code submission, the operative note must show the hernia repair as a discrete and significant part of the operation. Describe the hernia separately from the fundoplication narrative, including its size, type, contents and repair technique. Submit the claim with a covering letter explaining the clinical distinction.

Consult the CCSD technical guide for the current bundling framework, and verify with each insurer’s provider portal before submitting a dual-code claim.

Documentation requirements for G2400 claims

A G2400 claim that lacks evidence of both procedure components will be queried or denied on clinical grounds. UK private insurers audit the operative note first, and it must contain each element below to support the claim. Structured digital forms make it harder to leave a required field out at dictation.

• Confirmed transthoracic approach: State that the procedure was performed via thoracotomy, with laterality and incision type (for example “left posterolateral thoracotomy”). A note that does not confirm the thoracic route leaves the claim open to a code-selection challenge.
• Fundoplication wrap described: Name the technique used (Nissen 360-degree, Toupet 270-degree posterior, Belsey 270-degree anterior) and confirm the wrap was anchored to the oesophagus. Record the number of sutures and the degree of wrap.
• Gastroplasty component documented: Confirm that a Collis gastroplasty was performed. Record the staple or suture technique used to create the neoesophageal tube and its approximate length. Give the reason it was needed, such as a short oesophagus confirmed during surgery or by manometry or barium swallow.
• Anatomical findings: Record the condition of the gastro-oesophageal junction, any hiatal hernia characteristics, degree of oesophageal shortening, and mucosal appearances.
• Surgeon grade: State the grade of the operating surgeon. UK private payers pay different rates to a substantive consultant and an associate specialist. A grade mismatch between the claim and the payer’s contract triggers downgrading.
• Pre-operative workup: Reference the supporting investigations (24-hour pH study, manometry, endoscopy, barium swallow) that confirmed the indication for a transthoracic approach with gastroplasty.

Prior authorization: What UK private payers require for G2400

Prior authorization is standard for elective surgery under UK private medical insurance, and G2400 is no exception. Requirements vary by insurer and policy, so verify them on the provider portal before booking the procedure. The table below reflects general practice as of early 2026.

Authorization must be obtained before the procedure date. Late or retrospective requests are frequently declined or paid at a reduced rate. The authorization number must appear on the invoice, and the CCSD code authorized must match the code billed.

If the surgeon changes the approach during the operation, contact the insurer’s medical assessment team before the claim is submitted.

Common reasons G2400 claims are denied

Most G2400 denials are avoidable. The table below maps the most frequent denial reasons to their root cause and the corrective action. With surgical practice claims software, incomplete operative note fields get flagged before submission instead of after a denial.

CCSD bundling rules and global period for G2400

CCSD bundling policy decides which procedures in the same operative session fall within G2400’s reimbursement scope and which may be billed separately. The CCSD technical guide sets the framework, but individual payer schedules may apply stricter or more permissive rules. Keep each insurer’s bundling position on file so coders check it before submission.

Procedures typically included in G2400 (not separately billable)

• Routine crural suture repair of the diaphragmatic hiatus as part of fundoplication setup
• Intra-operative oesophageal dilation where performed as a preparatory step
• Division of short gastric vessels (mobilization of the gastric fundus) as a component of creating the wrap
• Anesthesia assist and standard surgical assistance included in the procedure tariff

Procedures that may be separately billed (payer-specific)

• Repair of a substantial para-oesophageal or giant hiatal hernia requiring mesh reinforcement, where documented as a distinct operative step
• Concurrent oesophageal stricture dilation performed as a separate therapeutic intervention with its own clinical justification
• Thoracic epidural catheter insertion for post-operative analgesia management, if billed separately by the anesthetist

Most CCSD payers do not publish a fixed global period for G2400 in the way that CMS defines global surgical packages for US CPT codes. Post-operative outpatient follow-up visits are generally billed separately under the appropriate consultation code. Confirm the specific global period, if any, with the individual insurer’s provider schedule before submitting follow-up claims.

Using Pabau to manage G2400 billing in UK private practice

A G2400 claim depends on four records lining up. They are the approach, both procedure components, the surgeon grade and an authorization obtained before surgery. When one slips, the denial arrives weeks later and takes consultant time to resolve.

In Pabau, the surgical team completes a structured operative form instead of free-text dictation. The approach, the wrap, the Collis gastroplasty, the anatomical findings and the surgeon grade are required fields. A missing-gastroplasty note gets caught before the claim is raised.

The note, the invoice and the authorization number sit on the same patient record, so the coder builds the claim from complete documentation. Claims then go to insurers through Healthcode without re-keying.

Manage CCSD billing without the admin overhead

Pabau helps UK private surgical practices capture operative documentation and submit CCSD-coded claims to insurers. Denial reasons across Bupa, AXA Health and Aviva are tracked in one system.

Book a demo

Conclusion

G2400 rewards the practice that documents in theatre. If the operative note names the thoracotomy and the Collis gastroplasty, the code holds up in audit. If it doesn’t, an appeal letter rarely repairs the damage in full.

The trade-off is a few minutes of structured note-taking against weeks of addenda and appeals. Settle any dual-code hiatal hernia claim with the insurer before surgery as well, and log the call reference.

Book a demo to see how Pabau’s structured operative forms keep G2400 claims complete before they reach the insurer.

Continue your research

Need a broader CCSD billing reference? Bupa CCSD procedure codes guide covers the Bupa fee schedule structure, how to look up codes, and submission requirements across the CCSD schedule.

Looking to reduce claim rejections across your practice? Claims management software from Pabau tracks submission status, denial reasons, and resubmission workflows for UK private insurer claims.

Billing a laparoscopic anti-reflux repair instead? CCSD code G2331 covers laparoscopic hiatus hernia repair with an anti-reflux procedure.

Working through a denial? Denial codes in medical billing explains what each denial reason means and how to resubmit.

Frequently asked questions