CCSD code K6020 – Resiting of pacemaker or ICD

Key takeaways

CCSD Code K6020 covers surgical relocation of a pacemaker or ICD generator to a new anatomical site, not local wound revision.

A generator swapped within the same pocket is K6030, so the operative note must name the new site to support K6020.

The primary clinical triggers are pocket infection, skin erosion, lead failure requiring new venous access, and radiation field conflicts.

Most UK private insurers (Bupa, AXA Health, Aviva, Vitality) require prior authorisation before K6020 is billed for elective resiting.

Pabau, the practice management platform we build, keeps CCSD codes, operative notes and insurer documentation on one patient record.

What CCSD Code K6020 covers

CCSD Code K6020 is the procedure code for resiting of a pacemaker or implantable cardioverter defibrillator (ICD). It sits in the Clinical Coding and Schedule Development (CCSD) schedule, the billing framework used across UK private health insurance.

“Resiting” means the existing generator is surgically removed from its subcutaneous pocket and re-implanted at a new anatomical location.

Typical moves are from the left pectoral region to the right, or from a pectoral site to an abdominal position. Revising or exploring the original pocket is a different procedure, and insurers treat that distinction as material when assessing claims.

K6020 applies to both single-chamber and dual-chamber pacemakers, and to ICDs of any configuration. The code does not differentiate by device type, but the documentation burden does. An ICD resiting may need defibrillation threshold (DFT) testing at the new site, which a pacemaker resiting does not.

What resiting a pacemaker or ICD involves

Resiting is a surgical procedure performed by a cardiac electrophysiologist, typically under general anaesthesia or deep sedation with local augmentation. The operative sequence differs from a straightforward generator replacement because the device must be physically moved rather than swapped in place.

The core steps are:

1. Original site opening. The surgeon reopens the existing pocket, disconnects leads from the generator, and removes the generator from the subcutaneous space.
2. Lead management decision. Where leads remain usable and venous anatomy allows, leads are re-tunnelled to the new site. Where leads cannot be re-routed or are failing, new leads are implanted via a separate venous access point.
3. New pocket formation. A fresh subcutaneous or submuscular pocket is created at the new anatomical location.
4. Device insertion and connection. The generator (same device or upgraded) is connected to the leads and secured in the new pocket.
5. Fluoroscopic confirmation. Imaging confirms lead position and generator seating at the new site.
6. Wound closure. Both the original and new sites are closed; original-site wound closure is integral to the resiting procedure.

For ICD resiting, the electrophysiologist will also perform DFT testing to confirm the device can deliver an effective shock from the new position. This testing adds procedural time and a separate documentation requirement.

Clinical indications for pacemaker and ICD resiting

UK private insurers assess medical necessity against accepted clinical indications. The following are recognised across Bupa, AXA Health, and Aviva policy frameworks. Each insurer’s accepted list may differ, so confirm it at the pre-authorisation stage.

• Pocket infection. The most common indication is active infection at the implant site that cannot be managed without removing the device and relocating it to clean tissue.
• Skin erosion. Generator or lead hardware erodes through the skin, which creates infection risk and calls for a site with adequate soft-tissue coverage.
• Lead failure requiring new venous access. A failing lead cannot be repositioned via the original venous route, so the device needs a new implant site with alternative venous anatomy.
• Radiation field conflict. The original device site falls within a planned or ongoing radiotherapy field. Relocation preserves device function and avoids tissue damage.
• Patient anatomy change. Significant weight change, post-mastectomy reconstruction, or thoracic surgery alters local anatomy so the original site is no longer viable.
• Chronic pain or discomfort. The patient has persistent, documented pain at the original site that has not responded to conservative management, and clinical review supports relocation.

The operative note must name the specific indication and explain why it makes the original site unsuitable. A general statement that the device was resited is not sufficient for most UK insurer claims.

K6020 within the CCSD K60 pacemaker code family

K6020 sits within the K60-series of the CCSD schedule, which covers cardiac pacemaker and ICD procedures. Neighbouring codes describe similar operations, so check where K6020 sits relative to them before you submit a claim. The table below lists the principal K60-series codes and how each differs from K6020.

Verify current descriptors against the live CCSD schedule before submitting claims, as code descriptors are subject to periodic update by the CCSD working group. Cardiac procedures outside the K60 series, such as coronary angioplasty, are listed in the CCSD code library.

Pocket revision, resiting, and generator replacement: Choosing the right code

The most common coding error on K6020 claims is conflating resiting with pocket revision or generator replacement. The table below clarifies the operative and coding distinction between the three.

The critical test for K6020 is whether the generator ends up in a different anatomical location after the procedure. Moving from the left pectoral region to the right pectoral region qualifies.

Repositioning within the same pocket following wound exploration does not. The flow below applies that test first, then rules out the neighbouring codes in order.

Documentation requirements for CCSD Code K6020 claims

Insurers scrutinise K6020 claims more closely than straightforward generator replacements because the clinical rationale for moving a device is less self-evident than a battery change. The operative note and supporting documents must collectively answer four questions:

1. Why was the original site unsuitable? Name the specific indication, such as infection, erosion or radiation field conflict. Then reference the evidence behind it, such as microbiology results, imaging, or oncology correspondence.
2. Where was the device moved to? State the new anatomical site explicitly (for example, right infraclavicular region, or left upper quadrant abdominal wall).
3. What was done at the original site? Describe closure, debridement (if infection was present), or any explantation of hardware that was not re-used.
4. How was the new position confirmed? Reference fluoroscopy or imaging confirmation of lead placement and device seating at the new site.

Additional documents that strengthen a K6020 claim include:

• device serial numbers for both the generator and the leads
• a pre-procedure echocardiogram or device check confirming the original site is unsuitable
• microbiology or wound swab results where infection is the indication
• for ICD resiting, a post-procedure DFT test report confirming effective shock delivery from the new position

Private practices using claims management software can build structured operative note templates that capture each of these elements as the note is written. That saves rebuilding a K6020 supporting pack from memory after the fact.

Prior authorisation for pacemaker and ICD resiting

Elective K6020 procedures almost universally require prior authorisation from the patient’s insurer. The major UK private insurers for cardiology practices include Bupa, AXA Health, Aviva, and Vitality Health. All four treat cardiac device surgery as a pre-authorisation category. Confirm the current requirement directly with each insurer, as pre-auth policies are updated periodically.

A typical prior authorisation request for K6020 includes:

• the referring cardiologist’s letter
• a clinical summary stating the indication
• imaging or microbiological evidence supporting the indication
• the proposed new implant site
• the treating electrophysiologist’s confirmation of medical necessity

Emergency resiting may proceed without prior authorisation, for example where acute pocket sepsis threatens systemic infection. In that case, notify the insurer within 24 to 48 hours and send retrospective documentation as soon as possible to preserve the claim.

Common reasons K6020 claims are denied

The following denial patterns appear consistently across Bupa CCSD billing and other UK private health insurer workflows. Catching them at the documentation and submission stage prevents the most frequent K6020 claim failures.

• Missing prior authorisation. The claim is submitted without an authorisation reference. Or the authorisation covers a different procedure, such as generator replacement, and was never updated to reflect resiting.
• Operative note does not document the new anatomical site. The note states the device was “resited” without specifying where. Insurers treat this as insufficient to confirm that a new site was created.
• Resiting not distinguished from replacement. The note reads as a generator replacement with some wound work, and the insurer re-codes to K6030. This happens when the procedure narrative focuses on the new device rather than on the site change.
• Incompatible companion code combination. K6020 billed alongside a pocket revision code in the same episode without documentation supporting both as separately necessary.
• Indication not supported by clinical evidence. Infection cited as the indication but no microbiology results or wound swab findings are included in the supporting pack.
• ICD DFT testing not documented for ICD resiting. Without post-procedure DFT documentation, an insurer may question whether a full ICD resiting took place. It may treat the operation as a partial repositioning instead.

Codes commonly billed alongside K6020

Several CCSD codes may be legitimately billed in the same episode as CCSD Code K6020, depending on what was performed. Whether each is separately billable or bundled within K6020 must be confirmed against the current CCSD technical guide, as bundling rules are subject to update.

The safest approach is to contact the patient’s insurer before submission when billing multiple codes in the same K6020 episode. An upfront bundling query takes minutes and prevents a denial that may take weeks to appeal.

How Pabau keeps K6020 claim packs complete

A K6020 claim is often assembled after the operation. The coder chases the operative note, the microbiology result, the device serial numbers and the authorisation reference from different systems. When one is missing, the claim goes out thin and comes back denied.

In Pabau, the operative note template can prompt for the indication, the new anatomical site and the imaging confirmation as the note is written. Insurer details and the authorisation reference sit on the same patient record. Claims then go to Bupa, AXA Health and other insurers through Healthcode.

Your team stops rebuilding supporting packs by hand, and each resiting claim reaches the insurer with the evidence that matches its code.

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Conclusion

Code K6020 only when the operative note proves the generator now sits at a new anatomical site. Every other version of the operation belongs to a neighbouring code, and insurers are quick to re-code a vague note to K6030.

The trade-off is time spent before the procedure. Securing prior authorisation for resiting specifically, and writing the note around the four documentation questions, takes minutes up front. It saves weeks of appeals later. For ICD resiting, attach the DFT report even when the policy does not ask for it.

Book a demo to see how Pabau keeps CCSD claims, operative notes and insurer authorisations on one patient record.

Continue your research

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