CCSD code G2400 – Transthoracic fundoplication and gastroplasty

Key Takeaways

CCSD code G2400 covers transthoracic fundoplication combined with gastroplasty as one bundled procedure code – the open thoracic approach distinguishes it from laparoscopic fundoplication codes

Both procedure components must be documented in the operative note: confirm the thoracotomy approach, the anti-reflux wrap technique (Nissen, Toupet, or Belsey), and the Collis gastroplasty oesophageal lengthening

Missing gastroplasty documentation and wrong approach selection are the two most frequent denial triggers for G2400 claims across UK private payers

Pabau’s digital forms and claims management tools help private surgical practices capture the specific operative data that G2400 claims require and submit them to UK insurers accurately

What is CCSD code G2400?

CCSD code G2400 is the procedure code in the Clinical Coding and Schedule Development (CCSD) schedule for transthoracic fundoplication and gastroplasty, billed as a single combined procedure in UK private healthcare. The code sits in the G-section of the CCSD schedule, which covers thoracic and upper gastrointestinal surgical procedures. Unlike laparoscopic anti-reflux procedures, G2400 specifically requires an open transthoracic approach, typically a left posterolateral thoracotomy, making it 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 have been performed to justify CCSD code G2400; performing only the fundoplication without a gastroplasty component would require selection of 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 accesses the distal oesophagus and gastro-oesophageal junction (GOJ) via the chest cavity rather than the abdomen, which distinguishes this approach from laparoscopic or open transabdominal fundoplication procedures and is the defining feature that triggers CCSD code G2400 rather than a laparoscopic-specific code.

The gastroplasty component addresses a short oesophagus. When gastro-oesophageal reflux disease (GORD) has caused fibrosis and oesophageal shortening, a standard fundoplication wrap placed under tension will fail and herniate back into the chest. Collis gastroplasty resolves this by creating a tubular extension of the oesophagus using the gastric cardia, effectively lengthening the food pipe before the wrap is applied. The combined G2400 procedure therefore addresses two pathological problems in a single operative session.

Named techniques billed under G2400

• Belsey Mark IV: a 270-degree partial anterior fundoplication performed via left thoracotomy; the archetypal transthoracic technique. The partial wrap reduces the dysphagia risk compared to a total 360-degree wrap in a transthoracic approach.
• 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 reserved for cases where laparoscopic fundoplication has failed, is technically unsuitable, or where the transthoracic approach offers a distinct advantage. Understanding the indications matters to billers because the operative note must link the chosen approach to a documented clinical reason, and insurers may scrutinise 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 superior access to 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: Cases where a thoracotomy is already indicated for another reason (for example, a paraoesophageal hernia with pleural involvement) and the anti-reflux procedure is 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 visualisation.

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 neighbouring CCSD codes: what is included and what is not

Selecting the correct CCSD code depends on the surgical approach and whether the gastroplasty component was performed. See Bupa CCSD procedure codes for the broader schedule context. The table below compares G2400 against the most commonly confused adjacent codes in the upper GI and thoracic sections.

*Exact adjacent code numbers vary by CCSD edition; verify against the current published schedule at ccsd.org.uk before submitting any claim. CCSD codes are periodically revised and coders should confirm G2400 is current in the latest edition.

Is hiatal hernia repair billable alongside G2400?

This is a payer-specific determination, and billers should not assume a blanket yes or no. Where hiatal hernia repair is an integral part of creating the correct anatomical environment for the fundoplication, most CCSD payer schedules treat it as included in G2400 and will not reimburse it separately.

Where the hernia repair is a substantial, clinically distinct procedure performed on a significantly enlarged or complicated hernia that required independent surgical attention beyond standard crural dissection, some payers will consider a separate code alongside G2400.

To support a dual-code submission, the operative note must document that the hernia repair was a discrete and significant component of the operation, with separate description of the hernia characteristics (size, type, contents, repair technique), independent of the fundoplication narrative. 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. The operative note is the primary document audited by UK private insurers and must contain all of the following elements to support the claim. Using digital operative note capture reduces the risk of omitting critical fields at time of dictation.

• Confirmed transthoracic approach: Explicitly state that the procedure was performed via thoracotomy (specify laterality and incision type, for example “left posterolateral thoracotomy”). A note that does not confirm the thoracic route leaves the claim open to 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; document the staple or suture technique used to create the neoesophageal tube, its approximate length, and the reason for its necessity (short oesophagus confirmed intra-operatively or pre-operatively by manometry/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 reimburse at different rates depending on whether the procedure was performed by a substantive consultant or an associate specialist, and 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 authorisation: what UK private payers require for G2400

Prior authorisation is standard practice for elective surgical procedures under UK private medical insurance, and G2400 is no exception. Requirements vary by insurer and policy, so always verify on the relevant provider portal before booking the procedure. The table below reflects general practice as of early 2026; check each insurer directly for current requirements.

Authorisation must be obtained before the procedure date. Late or retrospective authorisation requests are frequently declined or subject to reduced reimbursement. The authorisation number must appear on the invoice submitted to the insurer, and the CCSD code authorised must match the code billed. If the surgeon determines intra-operatively that the approach must change from the authorised plan, 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. Private surgical practices using claims management software can flag incomplete operative note fields before submission rather than chasing denials after the fact.

Manage CCSD billing without the admin overhead

Pabau helps UK private surgical practices capture operative documentation, submit CCSD-coded claims to insurers, and track denial reasons across Bupa, AXA Health, and Aviva from one system.

Book a demo

CCSD bundling rules and global period for G2400

CCSD bundling policy determines which procedures performed in the same operative session are included within G2400’s reimbursement scope and which may be separately billed. The CCSD technical guide sets the framework, but individual payer schedules may apply stricter or more permissive rules. Private practices using compliance management tools can track payer-specific bundling rules by insurer to reduce errors at 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 (mobilisation of the gastric fundus) as a component of creating the wrap
• Anaesthesia 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 by the anaesthetist separately

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

Private surgical practices handling G2400 claims face a specific documentation pressure: two procedure components, a specialist surgical approach, multiple payer-specific bundling rules, and a pre-authorisation workflow that must be completed before the procedure date. When any of these steps slip, the denial arrives weeks later and requires consultant time to resolve.

Pabau supports the end-to-end billing workflow for UK private surgical practices. Digital operative note capture lets the surgical team record approach, both procedure components, anatomical findings, and surgeon grade in a structured template, reducing the risk of a missing-gastroplasty denial at source.

The private practice billing workflow in Pabau routes completed operative documentation directly into the claim preparation step, so the coder works from a complete record rather than chasing the theatre team for addenda.

Conclusion

CCSD code G2400 is a combined procedure code with two non-negotiable components: an open transthoracic surgical approach and a Collis gastroplasty performed alongside the fundoplication wrap.

Claims fail most often because the operative note documents only the fundoplication, leaving the gastroplasty unrecorded and the code unjustified in the insurer’s audit. Getting the documentation right at the time of surgery is the only reliable way to avoid retrospective appeals.

Pabau’s structured operative note templates and claims management tools help UK private surgical practices capture the specific evidence that G2400 claims require before submission.

To see how the workflow fits your practice, book a demo.

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.

Want to ensure your surgical team’s documentation is complete? Compliance management tools in Pabau help private practices maintain consistent documentation standards across procedures and practitioners.

Frequently asked questions