CCSD code L1960 – Infrarenal AAA bifurcation graft

Key takeaways

CCSD code L1960 covers open repair of an infrarenal abdominal aortic aneurysm with a bifurcated (Y-shaped) graft, not a tube graft and not EVAR.

The operative note must confirm the open approach and the bifurcated graft, paired with an ICD-10 code such as I71.4 or I71.3.

UK private medical insurers such as Bupa, AXA Health and Aviva usually expect pre-authorisation before elective repair, under each insurer’s own rules.

Pabau’s claims management software sends CCSD claims through Healthcode and tracks them, while the coding decision stays with your coder.

CCSD code L1960: Definition and clinical scope

CCSD code L1960 describes the open surgical repair of an infrarenal abdominal aortic aneurysm (AAA) using a bifurcated graft. The Clinical Coding and Schedule Development (CCSD) Group maintains the schedule. UK private medical insurers, including Aviva, AXA Health and Bupa, own and license it, and consultant surgeons use its codes to bill them.

Among the CCSD codes, L1960 sits in the Abdominal Vessels section of Chapter 9, and CCSD added it on 7 February 2014. Its schedule descriptor is “Open infrarenal abdominal aortic aneurysm bifurcation graft”. US HCPCS also uses L1960, for a custom-fabricated ankle-foot orthosis, so check which code system a search result covers.

Three characteristics define this code. The repair is open rather than endovascular, and the aneurysm is infrarenal, below the renal arteries. The graft is bifurcated: Y-shaped, with two distal limbs. All three must be confirmed in the operative record before L1960 is assigned.

• Who performs it: A consultant vascular surgeon credentialed for major aortic surgery
• Setting: Hospital theatre, under general anaesthesia
• What it does NOT cover: Suprarenal or thoracoabdominal aneurysm repair, straight tube graft repair (L1940), EVAR (such as L2710), or laparoscopic-assisted techniques

The procedure: Infrarenal AAA bifurcation graft explained

An infrarenal AAA forms below the renal arteries. Approximately 90% of all abdominal aortic aneurysms are infrarenal, making this the most common anatomical site for open aortic surgery. Some aneurysms extend to the aortic bifurcation, where the aorta divides into the two common iliac arteries. Those need a bifurcated graft rather than a simpler tube graft.

The operative sequence that the coder will see documented in the theatre report follows these key steps:

1. Laparotomy: A midline or transverse abdominal incision exposes the retroperitoneum and aorta.
2. Aortic control: The surgeon clamps the infrarenal aorta above the aneurysm and controls both iliac arteries below it.
3. Aneurysm exclusion: The aneurysm sac is opened and the mural thrombus and atherosclerotic debris are removed. The sac wall is preserved to wrap around the graft later.
4. Bifurcated graft placement: A Y-shaped synthetic prosthesis, typically Dacron or PTFE, is sewn to the aorta above. Its two limbs are joined to the iliac or femoral arteries below.
5. Closure and reperfusion: The sac is closed over the graft, haemostasis is confirmed, and the abdomen is closed.

The Y-configuration of the graft is the operative detail that separates L1960 from the open tube graft code, L1940. If the operative note describes a single distal anastomosis without branching, L1960 does not apply.

Clinical indications for billing L1960

Coders must understand why the procedure was performed to verify that the claim is clinically supported. The main indications for open infrarenal AAA repair with a bifurcated graft are:

• Aneurysm diameter: Most guidelines support repair when an infrarenal AAA reaches 5.5 cm in men or 5.0 cm in women. Individual clinical factors can shift that threshold. Insurers look for the measured diameter in the imaging report and the operative note.
• Symptomatic AAA: Back or abdominal pain attributable to rapid expansion, regardless of size.
• Ruptured AAA: Emergency repair, associated with high operative risk and the ICD-10 code I71.3.
• Anatomical unsuitability for EVAR: A short or angulated infrarenal aortic neck, iliac access problems, or other anatomy that rules out endovascular repair.
• Bifurcation or iliac involvement: An aneurysm extending to the aorto-iliac bifurcation, which needs the Y-graft coded under L1960 rather than a tube graft.

ICD-10 diagnosis codes paired with L1960

Every L1960 claim needs a supporting diagnosis. The UK uses the WHO ICD-10 classification, and these are the primary pairings for this procedure.

The ICD-10 code must reflect the clinical presentation documented in the operative note and pre-operative imaging report. An elective repair billed with I71.3 (ruptured) for an intact aneurysm is a coding error and is likely to prompt an insurer query.

L1960 vs adjacent CCSD codes: Avoiding miscoding

The most common coding error for this procedure is choosing the wrong CCSD code after an incomplete reading of the operative report. The CCSD billing codes guide explains how the schedule is structured, and the table below maps the key distinctions for aortic aneurysm repair.

CCSD lists both L1960 + L1940 and L1960 + L2710 as unacceptable combinations, so only one of each pair is billed for the same repair. The full schedule sits behind a licensed login, so confirm these entries there before you submit. The decision path below runs the same checks in the order a coder meets them in the operative note.

Open repair vs EVAR: Coding implications

CCSD code L1960 applies only to open surgical repair. EVAR deploys a stent-graft through femoral artery access without a laparotomy, and it takes a separate endovascular code such as L2710.

The operative note is the deciding document. L1960 needs a documented laparotomy, aortic cross-clamp and open graft anastomosis. A report describing percutaneous or femoral-cutdown access and fluoroscopic graft deployment describes EVAR and must be coded that way.

Documentation requirements for a valid L1960 claim

A well-supported L1960 claim rests on the operative note. Sound medical billing documentation practice requires the coder to verify each of the following elements before submitting.

• Operative report: States infrarenal anatomy, open approach, cross-clamp placement and opening of the aneurysm sac. It also confirms the bifurcated graft, with distal anastomoses to both iliac or femoral vessels.
• Pre-operative imaging: CT angiography or duplex ultrasound confirming the infrarenal AAA and its dimensions, which supports the ICD-10 code and the clinical justification.
• Anaesthetic record: Confirms the procedure date, theatre time and the anaesthetist’s involvement.
• Theatre log: Hospital records corroborating the procedure and the implant used (graft type, manufacturer and batch number where the insurer asks for them).
• Pre-authorisation number: The reference the insurer issues before the elective procedure, quoted on the claim.
• ICD-10 code: Matched to the clinical presentation (I71.4 for intact, I71.3 for ruptured) and consistent with the imaging and operative findings.

If any of these elements is absent or inconsistent, the insurer is likely to query or reject the claim. Coders should request missing documentation from the clinical team before submission rather than submitting and appealing later.

Assistant and additional procedure fees with L1960

CCSD codes do not carry CPT-style modifiers. The CCSD technical guide sets the business rules for combining codes, including which codes cannot be billed together. What an insurer pays for each line is set by that insurer, not by the schedule.

Open AAA repair routinely needs a surgical assistant, because aortic control and graft handling happen at the same time. The anaesthetist also bills separately. Each insurer sets its own rules for assistant fees and for paying a second procedure in the same operation. Check the current rules for the patient’s insurer before you add a line to the claim.

Additional procedures and second consultants

Renal artery reimplantation or a separate endarterectomy can happen during the same open repair. Bill an extra CCSD code only when the operative note documents it as a distinct procedure. Then check that code against the schedule’s unacceptable combinations for L1960.

Where two consultants each perform a distinct part of the operation, the operative note must record who did what. Two surgeons being present is not enough. Insurers differ on whether and how they pay a second consultant, so confirm the policy before submitting.

Pre-authorisation requirements from UK insurers

UK private medical insurers usually expect the patient to obtain pre-authorisation before elective open AAA repair. The authorisation should name the same procedure the surgeon performs, so the codes need settling early.

1. Supply the planned codes: The surgeon’s team gives the patient CCSD code L1960 and the supporting ICD-10 code (usually I71.4) to quote to the insurer.
2. Provide clinical details if asked: Pre-operative CT angiography, aneurysm diameter, any symptoms, and why open repair was chosen over EVAR.
3. Cover the whole team: Ask whether the authorisation also covers the anaesthetist and any assistant, and add their details where the insurer requires them.
4. Record the authorisation number: Keep the reference the insurer issues, because it must appear on the claim.
5. Check the authorisation still fits: Each insurer sets how long an authorisation stays valid. If the date moves, or the plan changes between EVAR and open repair, contact the insurer before the operation.

Emergency (ruptured AAA): Many UK private medical insurance policies exclude emergency admissions, so most ruptured aneurysms are repaired in the NHS. Where a private claim does follow an emergency repair (ICD-10 I71.3), follow the insurer’s published process for retrospective authorisation. Send the operative report and emergency clinical notes with the request.

Why L1960 claims get queried or rejected

Claims for open AAA repair are high-value and draw close review from insurer claims teams. The most common rejection reasons and their corrective actions are:

A short pre-submission checklist that tests every claim against these rows stops each problem before the claim leaves the practice.

Billing L1960 in practice: A step-by-step claim walkthrough

Follow these steps for every L1960 claim before you send it to the insurer.

1. Confirm the operative note is complete. Retrieve the signed operative report. Check it states the infrarenal location, the open approach (laparotomy), aortic cross-clamp placement, the bifurcated graft and both distal anastomoses. If any of these is missing, ask the surgeon for an addendum before going further.
2. Select the correct CCSD code. Assign CCSD code L1960 only when the operative note confirms a bifurcated graft. A tube graft takes L1940, and endovascular repair takes an EVAR code such as L2710.
3. Assign the ICD-10 code. Match the diagnosis to the clinical record: I71.4 for an intact aneurysm repaired electively, I71.3 for a ruptured one. Add secondary codes for documented comorbidities, such as atherosclerosis or hypertension.
4. Add other fee lines correctly. List an assistant or an additional procedure only where the operative note documents it and the insurer’s rules allow it. Never bill L1940 or L2710 alongside L1960 for the same repair.
5. Attach supporting documents. Include the operative report, anaesthetic record, pre-operative imaging report and theatre log. Some insurers also ask for the graft implant label or batch number.
6. Include the pre-authorisation number. Quote the authorisation number on the claim. For an emergency case, include any retrospective authorisation reference the insurer issued.
7. Submit and track. Send the claim through Healthcode or the insurer’s own channel within that insurer’s deadline. Record the submission date and chase any claim the insurer has not settled within its published turnaround.

Submitting L1960 claims to UK insurers with Pabau

Vascular practices billing L1960 tend to lose time in the same places. Authorisation numbers sit in emails, invoices get typed twice, and nobody chases unpaid claims. Pabau, the practice management platform we build, keeps the patient, insurer details and invoice on one record.

From that record, Pabau’s claims management software builds the claim from the details already on file and sends it through Healthcode. Your team then tracks each claim’s status in one place. Pabau does not choose the CCSD or ICD-10 codes, so the coding decision stays with your coder.

The outcome is fewer high-value claims stuck in a spreadsheet, and a clear view of which insurer still has to pay.

Keep complex surgical claims moving

Pabau keeps authorisation numbers, insurer details and invoices on one patient record. It sends each claim through Healthcode and tracks it until the insurer settles.

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Conclusion

L1960 is a narrow code: open repair, infrarenal aneurysm, bifurcated graft. Change any one of those facts and a different CCSD code applies, usually L1940 or L2710. The operative note is what proves which one is right.

Code from the note, make sure the authorisation covers the open repair, and test every extra line against the schedule’s unacceptable combinations. Those three habits head off the queries that delay a high-value claim. To see how Pabau keeps CCSD claims moving through Healthcode, book a demo.

Continue your research

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Want fewer insurer queries on surgical claims? Claims management software shows how Pabau submits and tracks claims through Healthcode.

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