CCSD code K3100 – Open valvotomy

Key takeaways

CCSD Code K3100 covers open surgical valvotomy of any heart valve, performed under direct vision on cardiopulmonary bypass.

A closed mitral valvotomy on the beating heart bills under K3210, and a catheter-based balloon procedure under K3500.

The operative note must confirm the open approach, the valve operated on, bypass use and the nature of the incision.

UK private insurers including Bupa, AXA Health and Aviva expect prior authorisation before open valvotomy, and a missing reference is a common cause of denial.

Claims software such as Pabau stores each pre-authorisation as a case, so the authorisation code follows the appointment through to the claim.

CCSD Code K3100: Definition and official descriptor

CCSD Code K3100 is the Clinical Coding and Schedule Development (CCSD) Group’s code for “Open valvotomy”. The surgeon opens the chest, places the patient on cardiopulmonary bypass and splits the fused valve leaflets under direct vision. The code applies to any cardiac valve.

K3100 is a standalone code. It is the only code in the K31xx range of the current Bupa schedule. There is no valve-specific open valvotomy sub-code to rule out. Bupa’s February 2026 schedule lists it in Chapter 8, under Heart – Cardiac Surgery, in band CMO 5 with a fee of £2,172.

The CCSD schedule is the standard coding framework for UK private medical insurance (PMI) billing. The responsible consultant surgeon submits K3100 when an open valvotomy is billed to an insurer such as Bupa, AXA Health, Aviva or Vitality. Our CCSD codes for consultants library lists the neighbouring codes in the same chapter.

Always check which schedule edition the insurer is using, because descriptors and fee bands are reviewed periodically.

What does open valvotomy involve? The procedure explained

Open valvotomy is a cardiac operation in which the surgeon incises or splits fused valve leaflets (commissurotomy) to relieve stenosis. It is performed under direct vision through an open chest. It differs from closed valvotomy, coded K3210, and from percutaneous balloon valvuloplasty, which is catheter-based and needs no sternotomy.

The typical surgical sequence involves:

1. Median sternotomy – the chest is opened through the breastbone, giving direct access to the heart.
2. Cardiopulmonary bypass (CPB) – the heart-lung machine takes over circulation while the heart is stopped, so the surgeon can work on an open, still valve.
3. Valvotomy / commissurotomy – the surgeon incises the fused commissures (the junctions between valve leaflets) or the leaflets themselves to widen the valve opening.
4. Assessment and closure – valve function is assessed (often with intraoperative echocardiography), and the chest is closed in layers.

The primary indication is valvular stenosis, a narrowing of a heart valve that restricts blood flow. Open valvotomy may be chosen when percutaneous options are unsuitable, when the valve anatomy is complex, or when other cardiac surgery is planned. The operative note should describe each step clearly enough to support K3100.

Which heart valves does K3100 cover?

K3100 covers open valvotomy of any cardiac valve. The current schedule has no valve-specific open valvotomy code, so all four valves below map to K3100:

• Mitral valve (mitral stenosis) – historically the most common indication for open valvotomy, particularly in rheumatic heart disease
• Aortic valve (aortic stenosis) – less common given the prevalence of replacement, and more often seen in younger patients or as a bridge procedure
• Pulmonary valve (pulmonary stenosis) – performed in selected cases, particularly in paediatric or congenital cardiac surgery
• Tricuspid valve (tricuspid stenosis) – a rare indication, so the operative note must clearly describe the tricuspid approach

The one valve-specific valvotomy code sits next door. K3210 covers closed mitral valvotomy, done on the beating heart without bypass. The operative note’s record of the valve and of bypass use is therefore both a clinical and a coding requirement.

K3100 vs adjacent CCSD codes: What to use and when

Open valvotomy sits among several valve codes in the Heart – Cardiac Surgery section of the schedule. Picking the wrong neighbour is a common source of claim queries and rejections. Two questions about the operative note settle most cases, as the diagram below shows.

The table sets K3100 beside those codes, with each code’s band and fee from the February 2026 Bupa schedule where one code applies. Check descriptors against the Bupa CCSD procedure codes reference before billing.

Open valvotomy vs valvuloplasty: Coding the difference

The most common coding error on K3100 claims is swapping it with a percutaneous valvuloplasty code, or the reverse. The two are clinically distinct operations with different codes. Bupa’s schedule lists £2,172 for K3100 against £845 for K3500, so the error also changes the fee.

The documentary test is straightforward. If the procedure report describes an operating theatre, sternotomy and direct valve incision, code K3100. If it describes a catheterisation lab, vascular access and balloon inflation, code K3500. When an operative note describes only a “valve procedure”, query the responsible surgeon before submitting the claim.

Documentation requirements for billing K3100

A K3100 claim needs documentation that clearly supports the open surgical approach and the valvotomy as the primary procedure. Using claims management software to attach and track operative documents reduces the risk of a claim leaving without its evidence.

The operative note must contain all of the following:

• Confirmation of open surgical approach – sternotomy or another chest-opening technique, with the report stating how the chest was accessed
• Identification of the specific valve – mitral, aortic, pulmonary or tricuspid, which the insurer checks against the diagnosis code
• Nature of the valvotomy – whether the surgeon performed a commissurotomy (splitting fused commissures), leaflet incision, or both
• Use of cardiopulmonary bypass – bypass on the record confirms an open procedure, while a beating-heart mitral procedure points to K3210
• Intraoperative assessment – echo or direct assessment of valve function after the valvotomy confirms procedural intent and outcome
• Linked ICD-10 diagnosis code – the diagnosis should confirm stenosis of the named valve (e.g. mitral stenosis, aortic stenosis) to establish medical necessity

Insurers also expect the consultant surgeon’s name and GMC number, the procedure date, the clinical indication and the hospital on the invoice. An invoice missing any of these details gives the insurer grounds to query or deny the claim.

Prior authorisation: What UK private insurers require for K3100

Open valvotomy is a major elective cardiac operation, and mainstream UK private medical insurers require prior authorisation before treatment begins. Claims submitted without a valid pre-authorisation reference number are routinely rejected, whatever their clinical merit.

Specific requirements vary and should be confirmed with each insurer before the procedure. Typical pre-authorisation evidence includes:

• A written referral from a recognised GP or cardiologist
• Echocardiography or other imaging confirming the diagnosis and severity of stenosis
• The consultant cardiothoracic surgeon’s recommendation letter identifying the procedure as clinically indicated
• Confirmation that less invasive alternatives (including percutaneous valvuloplasty where suitable) have been considered
• The proposed CCSD code (K3100) listed on the pre-authorisation request

Each insurer publishes its own pre-authorisation pathways and coding requirements, through Bupa’s code lookup, AXA Health’s procedure code portal and Aviva’s fee schedule.

Check the K3100 pathway on the insurer’s provider portal before the procedure date. Portal guidance takes precedence over any third-party summary, including this one.

The pre-authorisation reference number issued by the insurer must appear on the invoice. If the procedure date, the procedure performed or the consultant differs from the pre-authorised details, contact the insurer before billing.

Common reasons K3100 claims are denied

K3100 claim denials cluster around a few predictable failures. Most are avoidable with a pre-submission check against the documentation requirements above.

• Missing or expired prior authorisation – the pre-auth reference was not obtained, has lapsed, or the procedure date falls outside the authorised window.
• Incorrect code submitted – K3100 is swapped with a percutaneous code (K3500), the closed valvotomy code (K3210) or a valve repair or replacement code.
• Insufficient operative note – the note does not confirm the open approach, the specific valve, or the nature of the incision. Insurers may request an addendum, and a claim without evidence of an open valvotomy will not be paid under K3100.
• Mismatched ICD-10 diagnosis code – the invoice diagnosis does not describe valvular stenosis, or names a different valve from the operative note.
• Billing consultant not recognised – the submitting surgeon is not on the insurer’s recognised specialist list, or the recognition has lapsed. Check recognition status before the procedure.
• Bundling errors with anaesthetic or assistant codes – codes the insurer considers bundled within K3100 are billed separately, or separately billable codes are left off.

When a denial arrives, request the denial reason code in writing. Review a denial citing “incorrect procedure code” against the operative note first. If the note supports K3100, submit a formal reconsideration with the note attached. A “not pre-authorised” denial needs escalating to the insurer’s provider relations team if authorisation was obtained.

Coding K3100 with associated procedures: Bundling and add-on codes

Open valvotomy is rarely the only procedure on an operative list. Knowing what can be billed alongside K3100, and what it already includes, is essential for accurate claim submission.

Cardiopulmonary bypass: Whether bypass is separately billable alongside K3100 depends on the insurer’s contract and the current schedule edition. Some insurers treat it as part of the primary cardiac surgical code, while others allow a separate bypass code. Confirm against the CCSD technical guide and the insurer’s fee schedule before billing it separately.

Surgical assistant: A recognised surgical assistant may be coded separately if the operative note documents their involvement. The insurer’s terms must also recognise assistant fees for this category of procedure. Confirm the assistant’s recognition status and the applicable code with the insurer before billing.

Anaesthetic codes: The anaesthetist bills separately, under their own CCSD codes and insurer recognition. The surgeon’s K3100 claim and the anaesthetist’s claim are submitted independently.

Concurrent cardiac procedures: When a second cardiac procedure is performed at the same sitting, both may be coded subject to the insurer’s unbundling rules. Coronary artery bypass grafting alongside the valvotomy is one example. Each concurrent procedure needs its own pre-authorisation reference. Check the Bupa procedure fee schedule and the insurer’s multiple-procedure reduction policy before invoicing.

How Pabau keeps K3100 claims complete before they reach the insurer

Billing a K3100 claim often means chasing paperwork across email, insurer portals and spreadsheets. The pre-auth reference sits in one place, the operative note in another and the invoice in a third.

Pabau, the practice management platform we build, keeps those pieces on the patient record. Each insurer pre-authorisation is stored as a case. Attach the case when booking the operation, and the authorisation code follows the appointment through to the claim.

Pabau then raises the invoice to the insurer at its contract rate. It sends private medical insurance claims through Healthcode to insurers such as Bupa, AXA Health and Vitality. Every outstanding K3100 balance sits in one claims dashboard, so your team can see which claims are still waiting on payment.

Managing CCSD billing across multiple insurers?

Pabau helps UK private healthcare practices track prior authorisation, attach operative documents, and submit CCSD-coded claims without the manual chasing. See how it works for cardiothoracic and specialist practices.

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Conclusion

Code K3100 when the operative note shows an open chest, bypass and a direct incision of fused leaflets, on any valve. When the note describes a beating-heart mitral procedure or a catheter route, the insurer expects K3210 or K3500 instead.

The coding decision is rarely where these claims fail. They stall on a lapsed pre-authorisation, or on an operative note that never states the approach. Fixing either before the operation takes a phone call, while fixing it after a denial means a reconsideration and a delayed fee.

Book a demo to see how Pabau links each pre-authorisation to the operation and the claim, so K3100 invoices reach the insurer complete.

Continue your research

Coding a valve repair rather than a valvotomy? CCSD code K2580 covers open repair of the mitral valve, including the documentation insurers expect.

Did the surgeon replace the valve instead? CCSD code K2600 explains how to bill an aortic valve replacement and when it applies.

Billing a redo mitral procedure? CCSD code K2542 sets out the revision replacement code and how it differs from a first-time operation.

Is the valve going into an existing conduit? CCSD code K1800 covers placing a valve into a cardiac conduit, plus the codes it cannot be billed with.

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