CCSD code K5380 – Repair of ventricular aneurysm

Key takeaways

CCSD code K5380 bills repair of ventricular aneurysm, an open-heart operation done on cardiopulmonary bypass. UK private medical insurers pay the surgeon’s fee against it.

Lead with I25.3 (Aneurysm of heart) as the primary diagnosis, and add I25.2 (Old myocardial infarction) when the aneurysm followed a heart attack.

Bupa, AXA Health, Aviva and Vitality expect elective treatment to be pre-authorised, so record the authorisation number before admission.

Common denials stem from a missing authorisation, a heart failure code as the sole diagnosis, or an operative note that never names the technique.

Pabau, practice management software for private practices, sends CCSD claims through Healthcode with the pre-authorisation code attached.

What is CCSD code K5380? Definition and official descriptor

CCSD code K5380 is the procedure code for “Repair of ventricular aneurysm” in the Clinical Coding & Schedule Development (CCSD) schedule.

UK private medical insurers and private hospitals use this schedule to bill and pay for specialist procedures. K5380 sits in Chapter 8 (Thorax and intra-thoracic organs), among the K-series cardiac surgery codes.

Cardiothoracic surgeons use K5380 to claim for open repair of a ventricular aneurysm, whether by linear repair, patch plasty or geometric reconstruction. Insurer schedules place it in the Complex band, as Freedom Health Insurance’s Chapter 8 schedule shows.

K5380 sits within a cluster of major cardiac surgery codes. Knowing where it falls in the CCSD procedure codes schedule helps coders pick the right code when the surgeon performs a related but distinct operation. A left ventricular reconstruction that goes beyond simple aneurysm repair is the usual example.

Who uses K5380?

Cardiothoracic surgeons, their medical secretaries and private hospital billing teams submit K5380 across the UK. Claims go to private medical insurers such as Bupa, AXA Health, Aviva and Vitality, mostly electronically through Healthcode.

A board of insurers and hospital groups maintains the CCSD schedule. It publishes code changes in regular bulletins, so billing teams should check each new release. Teams that code several cardiac procedures can look up each one in our CCSD code library.

Ventricular aneurysm repair: Procedure overview

Repair of ventricular aneurysm involves open surgical correction of an aneurysmal segment of the ventricular wall. Most cases involve the left ventricle (LV) after a myocardial infarction.

A transmural infarction turns living myocardium into a thin, akinetic or dyskinetic fibrous scar. Congenital ventricular aneurysms (coded under Q24.8) are far less common but also captured by K5380.

Three main surgical techniques map to this code. The operative report must clearly state which was performed, because technique drives both documentation and the insurer’s view of medical necessity.

All three techniques are performed on cardiopulmonary bypass (CPB), using the heart-lung machine to maintain circulation while the surgeon works on the arrested heart. Off-pump ventricular aneurysm repair is theoretically possible but extremely rare in standard practice.

Clinical indications for K5380

Not every ventricular aneurysm needs surgery. Many patients with a small, stable aneurysm are managed with medication and follow-up imaging. Surgery is usually considered when the aneurysm causes symptoms or complications, such as:

• Heart failure: Breathlessness and fatigue that persist despite optimal medical therapy, because the aneurysm wastes part of each heartbeat
• Angina: Chest pain from coexisting coronary artery disease, often treated with bypass grafting at the same operation
• Ventricular arrhythmias: Dangerous heart rhythms arising from the scar at the edge of the aneurysm
• Thromboembolism: Clot forming inside the aneurysm sac and travelling to the brain or limbs

The referral and pre-authorisation request should state which of these indications applies. Insurers read the clinical indication alongside the imaging to judge medical necessity.

Dor procedure vs linear aneurysmectomy: How technique affects code selection

CCSD code K5380 captures both the linear aneurysmectomy (Cooley repair) and the endoventricular patch plasty (Dor procedure) when the aim is to repair the aneurysm.

The distinction matters when the operation is really a full surgical ventricular restoration (SVR) or geometric left ventricular reconstruction (LVR). Those operations target diffuse ischaemic cardiomyopathy, coded I25.5, rather than a discrete aneurysm.

Insurers may challenge a K5380 claim when the operative report describes extensive ventricular remodelling. The risk is highest when neither pre-operative imaging nor the surgeon’s findings confirm a discrete aneurysm.

To stay safe, confirm the aneurysm diagnosis in both the pre-operative investigation report and the operative note before submitting K5380. The diagram below shows how that confirmed finding decides between K5380 and two neighbouring cardiac codes.

ICD-10 diagnosis codes to pair with CCSD code K5380

Incorrect ICD-10 diagnosis pairing is a common cause of K5380 claim rejection. The diagnosis code must match the documented aetiology and the anatomical finding. It must also agree with the diagnosis on the pre-authorisation request.

I25.3 is the primary diagnosis for the overwhelming majority of K5380 claims. Adding I25.2 as a secondary code clarifies the post-infarct aetiology and strengthens medical necessity. Insurers may query claims coded only with a heart failure code (I50.x) without a primary aneurysm diagnosis.

Related and add-on CCSD codes: What to bill alongside K5380

Ventricular aneurysm repair is rarely an isolated procedure. Most patients also have coronary artery disease, so bypass grafting at the same operation is common. Insurers apply their own rules to multiple procedures at one sitting, so check each insurer’s guidance before you add codes.

Never bill a routine part of the main operation as a separate code. Insurers treat that as unbundling, and it is a common reason for a query from Bupa, AXA Health, Aviva or Vitality.

Prior authorisation requirements for K5380

UK private medical insurers expect elective treatment to be pre-authorised before admission, and cardiac surgery is no exception. Usually the patient calls the insurer for an authorisation number, and the surgeon supplies the clinical details.

Requirements differ by insurer and policy. The steps below reflect common practice at Bupa, AXA Health, Aviva and Vitality, but confirm the rules for each patient’s policy.

1. Confirm the patient’s cover: Check that the policy covers cardiac surgery, and that the insurer recognises both the hospital and the consultant.
2. Prepare the clinical details: Give the diagnosis with its ICD-10 code, the imaging evidence and the indication. Name the proposed procedure as K5380, with the technique.
3. Include supporting investigations: Attach the cardiac imaging report (echo, MRI or ventriculogram), the cardiologist’s referral letter and any pre-operative risk assessment.
4. Record the authorisation number: Put the reference on the claim and in the patient’s file before the operation begins.
5. Emergency admissions: When K5380 is performed as an emergency, contact the insurer as soon as possible after admission. Late notification can leave the claim unpaid, so check each insurer’s policy terms.

Documentation requirements for ventricular aneurysm repair

A K5380 claim supported by a thin operative note is a claim at risk. Insurers review high-value cardiac claims closely, and the operative report is the main document that justifies the code billed. The clinical documentation requirements for K5380 are specific to this procedure and cannot be satisfied with a generic post-operative summary.

The operative report must include all of the following elements to support a successful K5380 claim:

• Confirmed aneurysm diagnosis: Pre-operative imaging findings (echocardiogram or cardiac MRI report confirming the aneurysm location, size, and wall motion) referenced in the operative note
• Intraoperative finding: Surgeon’s description of the aneurysm as visualised and confirmed at time of surgery (location, extent, tissue quality)
• Specific surgical technique: Explicit statement of whether linear aneurysmectomy, endoventricular patch plasty (Dor procedure), or geometric reconstruction was performed
• Cardiopulmonary bypass detail: Bypass start and finish times, cardioplegia method and aortic cross-clamp time
• Concurrent procedures: If CABG, mitral valve repair or thrombus removal was performed at the same sitting, describe each one separately with its own technique notation
• Outcome statement: Surgeon’s assessment of the result before chest closure (e.g. restored ventricular geometry, absence of residual wall motion abnormality)

Why K5380 claims get denied: Common coding errors and rejections

K5380 attracts insurer scrutiny because it is a high-tariff procedure and the technical distinction between aneurysm repair and broader ventricular reconstruction can be challenged. The most frequent denial reasons fall into five categories.

Appealing a denied K5380 claim: Step-by-step process

A denied K5380 claim can often be recovered. Start with the insurer’s own review process, because most documentation denials are fixed there.

If the claim is still declined, the patient, as the policyholder, can make a formal complaint to the insurer. The insurer has eight weeks to send a final response. After that, the patient can take the complaint to the Financial Ombudsman Service, normally within six months of the final response.

1. Request the denial reasoning in writing: Ask the insurer for the specific reason and its clinical rationale. This tells you whether the problem is administrative (missing documents) or clinical (medical necessity disputed).
2. Gather supporting documents: Compile the pre-authorisation reference, the full operative report, pre-operative imaging and the surgeon’s clinical letter.
3. Submit a written review request: Send it to the insurer’s claims or clinical review team. Quote the CCSD descriptor for K5380 from the Bupa code search or the insurer’s own schedule, cite the ICD-10 pairing and attach the corrected documentation.
4. Use the insurer’s complaints process if the review fails, and ask for a final response letter.
5. Escalate to the Financial Ombudsman Service once the insurer has issued its final response, or after eight weeks without one. The patient brings this complaint, so give them the surgeon’s supporting letter.

A clinical letter from the operating surgeon, sent with a corrected operative report, often resolves a documentation denial at the first review.

How Pabau supports accurate CCSD billing for cardiac procedures

On a K5380 claim, the insurer’s authorisation, the surgeon’s operative note and the claim itself often sit in three different places. Pabau keeps all three on one patient record through its private practice claims software. Your billing team then codes from the surgeon’s own note, with the authorisation already attached.

For UK cardiothoracic practices, these Pabau features matter most for K5380 billing:

• Healthcode claims: Pabau sends private medical insurance claims through Healthcode to Bupa, AXA Health, Aviva, Vitality and WPA.
• Pre-authorisation cases: Each insurer authorisation is stored as a case. Attach it when booking, and the authorisation code follows the appointment through to the claim.
• Missing-code flags: Any claim still missing an authorisation code is flagged with “Assign case” before it goes out.
• Claim validation: Pabau catches missing or invalid details before you submit. If the insurer rejects a claim, Pabau shows the reason so you can correct it and resubmit.
• Claims dashboard: Track each claim from Pending to Paid, filter by insurer, or search by authorisation code.

Still comparing systems for a UK private practice? Our guide to the best UK medical billing software sets out the options side by side.

Reduce K5380 claim denials with smarter billing workflows

Pabau helps UK cardiothoracic practices track pre-authorisations, attach operative notes and send clean CCSD claims through Healthcode. See how it supports high-value cardiac procedure billing.

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Conclusion

Most K5380 queries trace back to three errors. The claim goes out without its authorisation number, a heart failure code stands in for the aneurysm, or the operative note never names the technique.

Fix them at source and the billing team rarely sees a query. The surgeon names the technique, the coder leads with I25.3, and no claim leaves without its authorisation reference.

Cardiothoracic practices that hold every claim to those checks spend far less time on appeals. Book a demo to see how Pabau keeps K5380 authorisations, operative notes and Healthcode claims in one workflow.

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