CCSD code H3364 – Laparoscopic high anterior resection

Key takeaways

CCSD code H3364 covers a laparoscopic high anterior resection, with the colorectal anastomosis formed above the peritoneal reflection. It sits in Chapter 11, under Rectum / Anus.

The anastomosis level and the approach decide the code. A laparoscopic low join is H3365, the open high resection is H3332, and the robotic-assisted high resection is H3370.

CCSD lists H3364 as unacceptable with Hartmann’s procedure (H3362), both open anterior resections (H3332, H3334), left hemicolectomy (H0900) and laparoscopic adhesiolysis (T4300).

Total mesorectal excision has its own codes. CCSD refuses laparoscopic TME (H3385) and robotic TME (H3383) alongside H3364, so bill the one code that matches the operation.

Insurers query notes that give only the join height, so state in words that the join sits above the peritoneal reflection.

What CCSD code H3364 covers and when it fits

CCSD code H3364 covers a laparoscopic anterior resection of the rectum, where the colorectal anastomosis is formed above the peritoneal reflection. CCSD calls this a high anterior resection.

The Clinical Coding & Schedule Development (CCSD) Group lists it in Chapter 11, Abdomen (excluding urinary and reproductive organs). It sits in sub-chapter 11.6.0, Rectum / Anus, and entered the schedule on January 20, 2010.

Three facts in the operative note decide whether H3364 fits. The approach is laparoscopic, the rectum is resected with a colorectal join, and that join sits above the peritoneal reflection. Change any one of them and the code changes.

High anterior resection is most often performed for cancer of the upper rectum or the rectosigmoid junction. Other indications include complicated sigmoid diverticular disease and benign tumors too large for local excision. Our CCSD guides for surgeons cover the other Chapter 11 procedures.

Each step of the operation leaves a clue for the coder

Before submitting H3364, the coder needs specific wording from the operation note. Knowing the operative steps tells them where to look.

• Laparoscopic access: The surgeon places the ports and inspects the abdomen. This keyhole approach is what separates H3364 from the open high resection code, H3332.
• Colon mobilization: The sigmoid and descending colon are freed from their attachments, and the inferior mesenteric vessels are divided. The splenic flexure may be mobilized to give a tension-free join.
• Upper rectal dissection: The upper rectum and its mesorectum are dissected to a point below the diseased segment. The dissection stays above the peritoneal reflection.
• Division and extraction: The rectum is divided with a laparoscopic stapler, and the specimen comes out through a small extraction incision.
• Colorectal anastomosis: The colon is joined to the rectal stump, usually with a circular stapler passed through the anus. The surgeon records where the join sits relative to the reflection.
• Leak testing: The join is usually tested by insufflating air under saline. The test is part of the resection, so it carries no code of its own.

Cancer and diverticular disease top the H3364 indication list

UK private medical insurers expect a diagnosis code with every H3364 claim. The table lists the indications that most often lead to a high anterior resection, with their ICD-10 codes.

Check each code against the NHS Classifications Browser before submission, since annual updates apply. The diagnosis should also match the indication recorded in the pre-authorization request.

For the cancer cases, our pages on C20 and C19 walk through how each tumor site is coded.

The peritoneal reflection decides H3364 or H3365

The peritoneal reflection is where the peritoneum folds from the pelvic wall onto the front of the rectum. A join above that fold makes the operation a high anterior resection. At or below it, the laparoscopic code becomes H3365.

The surgeon judges the reflection under direct vision, and its position varies between patients. A note that gives only the anastomosis height, such as “join at 12 cm”, leaves the code level open to query.

The surgical approach changes the code as well

CCSD gives each approach to an anterior resection its own code, and the join level splits each approach again. An open or robotic case billed as H3364 is miscoded, even when the insurer’s fee happens to match.

A laparoscopic case sometimes converts to open. Record the point of conversion and the reason in the note, then ask the insurer whether it wants H3364 or H3332 for that claim.

H3370 arrived in the schedule on April 15, 2024. Its descriptor already allows for a stoma, so a separate stoma code never goes on the same claim.

Does H3364 include total mesorectal excision?

No. CCSD codes total mesorectal excision (TME) as a procedure in its own right. The codes are H3384 for open, H3385 for laparoscopic, H3386 for transanal and H3383 for robotic-assisted TME.

CCSD lists both H3385 and H3383 as unacceptable combinations with H3364. If the note records a TME, choose the one code that describes the operation performed rather than billing the pair.

The grid below puts the approach, the join level and TME side by side. Read the note against it and one code drops out.

CCSD refuses 13 codes alongside H3364

The CCSD schedule names the codes that cannot be billed with H3364 for the same operation. Most describe a different resection of the same bowel, an endoscopy within the procedure, or a different route.

The CCSD Group publishes these pairs but does not set fees or decide reimbursement. Each insurer applies its own view, so confirm any borderline pairing before submission. The CCSD technical guide (October 2025) sets out the general unbundling principles.

A few codes can still share the claim with H3364

A few procedures performed in the same episode can be claimed alongside H3364. Each one needs its own supporting line in the operative note.

• Defunctioning ileostomy: A separate Chapter 11 ileostomy code may apply when a temporary stoma protects the join. Some insurers treat it as part of the resection fee, so confirm before submission.
• Anesthesia: The anesthetist bills separately under the insurer’s anesthetic fee schedule. The surgeon never includes it in the H3364 claim.
• Leak testing: This has no standalone code, so record the method and result in the note rather than on the invoice.

The open low resection, with its own stoma and TME guidance, is covered in our page on H3334.

Seven details every H3364 operative note should record

The operative note is the evidence behind every H3364 claim. When an insurer queries this code, one of these seven details is usually missing.

• Approach: State that the resection was laparoscopic, and record any conversion to open with its reason.
• Anastomosis level: Place the join above the peritoneal reflection in words, not only as a height from the anal verge.
• Extent of resection: Name the segments removed, such as the sigmoid colon and upper rectum, and the level of division.
• Mesorectal excision: Say whether a partial or total mesorectal excision was performed, since a TME points to a different code.
• Leak test result: Record the method and whether the join was airtight.
• Stoma: If a defunctioning stoma was formed, state its type and the clinical reason.
• Complications: Note any finding that changed the planned operation, including a conversion decision.

Get pre-authorization before you list the patient

Anterior resection is major elective surgery, and UK private medical insurers check it before admission. Requirements vary between insurers and policies, so confirm the steps with each one before you list the patient.

• Referral: A GP or specialist referral confirming the indication and the planned operation.
• Code for the planned approach: Request authorization for H3364 when the plan is laparoscopic. If the plan changes, tell the insurer before the claim goes in.
• Diagnosis and staging: For cancer, staging investigations such as CT and pelvic MRI should be complete and available to the insurer.
• MDT discussion: For cancer cases, record the multidisciplinary team’s recommendation for resection.
• Authorization number: Record it before the operation date and include it on the invoice.

Each insurer also publishes its own code lookup, which shows its fee and any code-level rules for its members.

How an H3364 claim moves from operation to payment

Most UK private practices send H3364 claims electronically through Healthcode, though some insurers also accept claims through their own portals.

1. Confirm cover: Check that the patient’s policy is active and covers the operation, and note the membership number.
2. Obtain authorization: Send the insurer the planned code, the diagnosis and the consultant’s details, then record the authorization number.
3. Document the operation: Complete the operative note with the approach, the anastomosis level and any TME or stoma.
4. Check the code: Match the note against H3364, H3365, H3332 and H3370, and remove any code on CCSD’s unacceptable list.
5. Build the invoice: Add H3364, the ICD-10 diagnosis, the procedure date and the authorization number to the claim.
6. Submit and track: Send the claim through Healthcode or the insurer portal, and answer any query within the insurer’s stated deadline.

Why H3364 claims bounce back, and how to stop it

Rejections on H3364 tend to repeat, and most trace back to the operative note or the code choice. The table maps each one to its fix.

Before you submit: A five-point check

Run through these five checks on every H3364 claim before it goes out. Each one maps to a rejection in the table above.

• The note states a laparoscopic approach and records any conversion to open.
• The join is placed above the peritoneal reflection in words, not only in centimeters.
• No TME was performed, or the matching TME code replaces H3364.
• No code from CCSD’s unacceptable list sits on the same claim.
• The ICD-10 diagnosis and the authorization number match the pre-authorization.

How Pabau keeps each H3364 claim complete

Many colorectal practices still track claims across operation notes, spreadsheets and insurer portals. Each handoff is a chance to lose the authorization number or key in the wrong approach code.

Pabau, the practice management platform we build, puts the CCSD code, the ICD-10 diagnosis and the authorization number on one claim record. Its claims management software checks that the required claim fields are filled before you send, then submits through Healthcode.

You track each claim’s status against the patient record, so a query from the insurer lands with the documents needed to answer it. Pabau does not choose the code for you, so the level and approach checks above still apply.

Groups with several consultants or sites can run the same billing process at every location.

Manage CCSD billing from authorization to payment

Pabau helps colorectal surgery teams keep the CCSD code, diagnosis and authorization number on one claim and submit it through Healthcode.

Book a demo

Conclusion

H3364 is settled in the operating room, long before anyone opens the claim. Once the surgeon records the route, the join level and any TME, the coding is mostly done.

That means a little more detail in every note. In return, the billing team stops chasing surgeons for answers weeks after the operation, and insurers have less reason to query.

So build the reflection line into your operative note template, and keep CCSD’s unacceptable list beside the person who submits. If you’d like to see how Pabau holds the code, diagnosis and authorization on one claim, book a demo.

Continue your research

Coding an open low resection instead? CCSD code H3334 covers the open anterior resection with the join at or below the peritoneal reflection.

Removing the rectum and anus with no join? CCSD code H3320 walks through abdominoperineal resection and its permanent colostomy.

Checking what Bupa pays for colorectal codes? The Bupa procedure codes and fee schedule guide links each code to its published fee before you invoice.

Choosing software to bill UK insurers? Our roundup of the best medical billing software in the UK compares tools for insurer claims, invoicing and payment tracking.

Coding the diagnosis for a rectal cancer case? ICD-10 code C20 explains the diagnosis code for malignant neoplasm of rectum.

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