CCSD code L0620 – Shunt between the aorta and pulmonary artery

Key takeaways

CCSD Code L0620 covers first-time surgical creation of a communication between the aorta and the pulmonary artery, not revision or takedown of an existing shunt.

A modified Blalock-Taussig shunt from the subclavian artery has its own code, L0710, so it is never billed as L0620.

Primary indications include pulmonary atresia, tetralogy of Fallot with severe outflow obstruction, and other duct-dependent cyanotic congenital heart lesions.

The operative report must name the vessels joined, the conduit material and size (where used), the surgical approach, and on- or off-bypass status.

Pabau, the practice management platform we build, keeps the operative note, the pre-authorisation reference and the claim on one patient record.

CCSD Code L0620: Definition and clinical description

CCSD Code L0620 is the UK private healthcare billing code for the surgical creation of a communication between the pulmonary artery and aorta.

The official descriptor reads: Creation of communication between pulmonary artery and aorta. It captures the first, deliberate construction of an aortopulmonary connection, whether through a prosthetic conduit or a direct vessel-to-vessel anastomosis.

L0620 sits in the Great vessels section (8.10) of CCSD Chapter 8, “Thorax and intra-thoracic organs”. That section holds the other CCSD codes for surgery on the aorta and pulmonary arteries. Bupa, AXA Health, Aviva and Vitality all use the schedule.

Two points anchor correct code selection. First, L0620 describes creation, meaning the first-time construction of an aortopulmonary communication. Revision, takedown or ligation of an existing shunt is never billed as L0620.

Second, the code is defined by the two vessels joined: the aorta and the pulmonary artery. A shunt that starts from the subclavian artery is coded as L0710 instead.

The procedure: Creating a communication between the pulmonary artery and aorta

Creating a communication between the pulmonary artery and aorta is a palliative cardiac operation. It increases blood flow to the lungs when the patient’s own pulmonary circulation can’t sustain adequate oxygenation. The usual cause is severe outflow obstruction or pulmonary atresia.

The new channel sends blood from the aorta back into the pulmonary circulation, which raises arterial oxygen saturation. That buys time until the patient is large enough, or stable enough, for definitive repair.

Coders should know the named techniques, because the operative report will use them. The vessels each technique joins decide whether L0620 applies.

• Potts shunt: A direct anastomosis between the descending aorta and the left pulmonary artery. It is rarely used for cyanotic heart disease today, but has seen a revival for refractory pulmonary arterial hypertension. As a direct aorta-to-pulmonary artery connection, it fits the L0620 descriptor.
• Waterston shunt: An anastomosis between the ascending aorta and the right pulmonary artery. It was largely abandoned because it can distort the pulmonary artery, but it still turns up in older patients and historical notes. It also joins the aorta to the pulmonary artery, so it falls under L0620.
• Central shunt: A prosthetic tube graft placed between the ascending aorta and the main pulmonary artery. The conduit joins the two vessels L0620 names, so the code applies.
• Modified Blalock-Taussig shunt (mBTS): The most common systemic-to-pulmonary shunt in current paediatric cardiac surgery. A Gore-Tex (PTFE) tube graft joins the subclavian or innominate artery to the pulmonary artery. CCSD gives it a dedicated code, L0710 “Creation of shunt from subclavian artery to pulmonary artery”, so it is not L0620.

The quickest check is to read which two vessels the operative note says were joined, as the chart below shows.

The operation may be performed via median sternotomy or lateral thoracotomy. It can be done on cardiopulmonary bypass (CPB) or off-pump, depending on the surgeon’s technique and the patient’s anatomy. The operative note must state which approach was taken, because both details affect documentation completeness for L0620 claims.

Clinical indications: When is L0620 performed?

Surgical creation of a pulmonary artery-to-aorta communication is performed in cyanotic congenital heart disease, where pulmonary blood flow is severely restricted or absent. These are the principal clinical scenarios behind a CCSD Code L0620 claim.

• Pulmonary atresia: The pulmonary valve or the right ventricular outflow connection is missing entirely. With or without a ventricular septal defect, the neonate depends on a patent ductus arteriosus for pulmonary blood flow. Once the duct starts to close, a surgical shunt is needed immediately.
• Tetralogy of Fallot (TOF) with severe outflow obstruction: Pulmonary blood flow is too low to keep saturations acceptable. The infant is not yet ready for complete repair. A palliative shunt buys time for growth before definitive surgery.
• Critical pulmonary stenosis: Severe pulmonary valve stenosis where balloon valvuloplasty has failed or is not feasible, so pulmonary blood flow must be increased surgically.
• Other duct-dependent cyanotic lesions: Tricuspid atresia, double-inlet left ventricle, and complex single-ventricle anatomies where the right heart can’t supply the pulmonary circuit.

In each case, the procedure is explicitly palliative. The operative report typically documents the preoperative oxygen saturation, the clinical urgency, and the planned staging toward definitive repair. Reference these details in the billing documentation, because they support the medical necessity of the claim.

For single-ventricle patients, the shunt is often the first of several staged operations. The later atrio-pulmonary connection, or Fontan-type procedure, is billed under its own code, L0610.

CCSD L0620 vs related shunt and cardiovascular codes

The most costly coding error with L0620 is selecting it for a revision or takedown of an existing shunt. The second is using it for a shunt that starts at the subclavian artery. The table below summarises the key distinctions within the Great vessels section.

Coding caution: The schedule runs from L0620 straight to L0710, with no dedicated code for taking down or revising a shunt. When a shunt is taken down during definitive repair, the repair code normally describes the whole intervention.

Check with the insurer before adding a second code. Before assigning L0620, confirm in the operative note that the shunt was newly constructed in that session.

Correct ICD-10 diagnosis codes to pair with CCSD Code L0620

UK insurers expect an ICD-10 diagnosis code alongside CCSD Code L0620 to establish medical necessity. The table lists the principal diagnosis codes most often submitted with L0620. The congenital heart defect driving the procedure is generally the principal diagnosis, with additional codes for any associated anomalies.

Always confirm codes against the current UK edition of ICD-10, the fifth edition that NHS England maintains for classification use. A mismatched or outdated diagnosis code is one of the most common avoidable denial triggers for this procedure.

Documentation requirements for L0620 claims

A defensible CCSD Code L0620 claim rests on the operative report. Insurers and billing reviewers look for specific elements, because vague documentation on a procedure this complex is a denial risk. These elements must appear in the operative note.

• Vessels anastomosed: The report must name both ends of the communication created, for example “the main pulmonary artery and the ascending aorta”. Generic language such as “shunt created” is not sufficient.
• Surgical approach: Median sternotomy or lateral thoracotomy. The approach affects anaesthetic coding and is a basic documentation requirement for every cardiac surgery CCSD code.
• On or off cardiopulmonary bypass: The note must state whether CPB was used. Off-pump and on-pump creation have different anaesthetic and perfusion implications, and auditors check the distinction.
• Conduit material and size (if applicable): Where a prosthetic tube graft is used, the report must state its material, such as Gore-Tex PTFE. It must also give the graft diameter in millimetres. This separates conduit-based shunts from direct anastomoses.
• Palliative intent documented: The note should make clear the procedure is palliative, citing the preoperative oxygen saturation, diagnosis and planned staging. This supports medical necessity if the claim is reviewed.
• Surgeon attestation: The operating surgeon must sign and date the operative report before the claim is submitted.

Templates that prompt for operative detail at the time of dictation are more reliable than completing the documentation afterwards. They also reduce the risk that one of these elements is missing at submission.

Prior authorisation and payer requirements for CCSD L0620

Most UK private medical insurers that accept CCSD billing require pre-authorisation for CCSD Code L0620. This is a major cardiac operation performed mainly in neonates, so authorisation is almost always in place before the patient reaches theatre. The billing team confirms that the authorisation reference on file matches the procedure code being submitted.

• Emergency and urgent neonatal presentations: A neonate with pulmonary atresia whose duct is closing may need surgery the same day. Most insurers offer an expedited or retrospective authorisation route for these cases. The clinical urgency must be documented in the operative note and in the hospital’s communication with the insurer. The route varies by insurer, so confirm it with the hospital’s admissions team.
• Elective staging: Where the shunt is a planned palliative stage before definitive repair, standard pre-authorisation applies. Submit the request well in advance, with the diagnosis codes and the CCSD procedure code (L0620) specified.
• Authorisation number on claim: The authorisation reference must appear on the claim. A missing or mismatched number triggers a rejection that delays payment, even when the coding is correct.

Pre-authorisation rules vary by insurer and policy, so check requirements directly with the insurer before each admission. The Healix fee schedule and the portals of Bupa, AXA Health, Vitality and WPA each publish their own prior-approval requirements for cardiac surgical codes.

CCSD L0620 fee schedule and reimbursement

CCSD defines the code, but each insurer sets its own fee for it and reviews that fee regularly. Freedom Health Insurance’s June 2026 schedule, for example, rates L0620 as Complex, with a £1,600 specialist fee and an £857 anaesthetist fee.

Look up the code on the CCSD official schedule, then check the fee in the relevant insurer’s own fee finder. Several factors affect what the insurer reimburses for an L0620 claim, even when the code is correct.

• Insurer fee vs the consultant’s charge: Each insurer pays its own fee for L0620. If the surgeon charges more than that fee, the patient may have to pay the difference, so agree the charge before admission.
• Multiple codes in one session: CCSD’s technical guide says no common clinical intervention should routinely need more than one code. Each insurer applies its own contractual rules when two codes are billed for one session, so contact the insurer before adding a second code. Check CCSD’s unacceptable-combination rules too.
• Assistant surgeon fees: A cardiothoracic assistant is standard for a procedure this complex. Where the insurer pays an assistant’s fee, the claim must reference L0620 and the principal surgeon’s provider number.
• UK insurers: Bupa, AXA Health, Vitality Health, WPA and others each publish their own rates for this code. Our guide to Bupa CCSD codes explains how Bupa applies the schedule. Cross-reference the CCSD technical guide for business rules before submitting.

Common claim denial reasons for CCSD Code L0620

Denial patterns for CCSD Code L0620 are predictable. Most rejections stem from incomplete documentation or code-selection errors, not clinical disputes about medical necessity. Fixing these before submission is far cheaper than managing appeals.

• Inadequate operative documentation: The note does not specify the vessels anastomosed, the conduit material or the surgical approach. Reviewers cannot assign L0620 with confidence when the report just says “shunt created”.
• Wrong code selected: L0620 is submitted for a revision or takedown of an existing shunt, or for a modified Blalock-Taussig shunt that belongs under L0710. Read the operative note carefully to confirm which vessels were joined and whether the shunt was new.
• Missing or mismatched prior authorisation: The authorisation number on the claim doesn’t match the insurer’s records. Or no authorisation was obtained, and the emergency route was not documented.
• Mismatched ICD-10 diagnosis codes: The diagnosis code does not match the documented indication, or comes from an outdated edition. Insurers run automated edits that cross-check procedure codes against acceptable diagnosis codes, and a mismatch triggers review.
• Assistant surgeon claim errors: The assistant’s claim references the wrong principal procedure code, or omits the principal surgeon’s provider details.
• Duplicate billing: L0620 is submitted twice in the same episode, or alongside a code that CCSD’s unacceptable-combination rules bar. Check the Bupa code lookup or the relevant insurer portal for code-specific rules before submitting.

Billing tips and coding best practices for CCSD L0620

Beyond avoiding denials, a few coding decisions affect how completely L0620 claims are paid and how well they stand up at audit.

Conduit vs direct anastomosis: Document the distinction clearly

Whether the surgeon used a prosthetic conduit (Gore-Tex PTFE graft) or a direct vessel-to-vessel anastomosis matters clinically and for the record. The operative note must make this explicit. A conduit-based shunt needs the graft size and material. A direct anastomosis needs the vessel diameters and the technique, such as end-to-side or side-to-side.

Re-do surgery and higher-complexity billing

L0620 is sometimes performed as a re-do operation, for example creating a new shunt after a previous one has thrombosed. The documentation should then reflect the extra complexity of re-operative cardiac surgery. Check whether your insurer’s schedule recognises re-operative complexity through an additional code.

The operative note must state that this is a re-do procedure. It should also describe the extra technical challenges, such as adhesions, altered anatomy or prolonged bypass.

Co-billing perfusion and anaesthetic codes correctly

Neonatal cardiac bypass cases involve perfusion services and complex anaesthetic management. Those claims are separate from the surgeon’s L0620 claim, but they must reference the same operative episode. Before anyone submits, confirm with the anaesthetist and perfusionist that their claims match the surgeon’s principal code and operating date.

Building these checks into a medical billing compliance routine stops misaligned co-submissions from tripping automated edits. It also takes the work off the surgical team.

How Pabau keeps L0620 claims complete before submission

Many cardiac billing teams still assemble an L0620 claim by hand. The operative note sits in one system, the pre-authorisation number in an email, and the invoice somewhere else. Each handover is a chance for the vessel detail or the authorisation reference to drop out.

Pabau keeps those pieces on one patient record. Its claims management software raises the claim from the patient’s invoice and sends it through Healthcode to insurers such as Bupa, AXA Health and Vitality. Each pre-authorisation is stored as a case, so its reference follows the appointment through to the claim.

Claim validation checks for missing or invalid details before the claim leaves Pabau. If an insurer rejects it, Pabau flags the claim with the reason, so your team can correct and resubmit it without starting again.

Send complete cardiac claims the first time

Pabau keeps operative notes, pre-authorisation references and insurer claims on one patient record. Claim validation flags a missing detail before the L0620 claim reaches the insurer.

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Conclusion

Getting L0620 right comes down to the vessels the surgeon joined. A direct aorta-to-pulmonary artery connection is L0620. A subclavian route is L0710, and a takedown or revision is never L0620.

The fixes are cheap compared with an appeal. Build the operative note template around the six documentation elements, and check the pre-authorisation reference before every submission. Confirm each insurer’s multiple-code rules before adding a second code.

Book a demo to see how Pabau helps cardiac billing teams send complete L0620 claims to UK insurers.

Continue your research

Repairing the pulmonary artery itself rather than creating a shunt? CCSD code L1080 covers open repair of the pulmonary artery and when it replaces a shunt code.

Coding an arch defect in the same congenital patient? CCSD code L2360 explains repair of an interrupted aortic arch and its documentation rules.

Is the aorta and pulmonary artery a single common trunk? ICD-10 code Q20.0 covers common arterial trunk, a congenital defect of the same great vessels.

Billing adult aortic surgery as well as congenital work? CCSD code L1880 sets out open repair of a leaking aortic arch aneurysm for UK insurers.

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