CCSD code L4140 – Endarterectomy of renal artery

Key takeaways

CCSD code L4140 covers open endarterectomy of the renal artery, not bypass, reconstruction, angioplasty or stenting.

CCSD is the UK procedure schedule that private medical insurers such as Bupa and AXA Health use, and it lists codes rather than fees.

L4140 sits in CCSD section 9.3.0 Renal under reference FI.018, beside L4190, L4292 and L4300.

ICD-10 code I70.1, atherosclerosis of renal artery, is the usual primary diagnosis on an L4140 claim.

Get the insurer’s authorization before admission, and quote the same code, diagnosis and authorization number on every invoice.

CCSD code L4140: Definition and procedure scope

CCSD code L4140 is the UK private healthcare procedure code for “Endarterectomy of renal artery.” It covers the open operation in which a vascular surgeon clears atherosclerotic plaque from inside a renal artery and closes the vessel.

The code comes from the CCSD schedule, maintained by the Clinical Coding & Schedule Development (CCSD) Group. UK private medical insurers, including Bupa and AXA Health, use the schedule to identify procedures on authorizations and specialist invoices.

The CCSD schedule lists codes and descriptors, not fees. Each insurer sets its own fee for L4140, so check the current fee schedule of the insurer you are billing. Code lookups on the CCSD website need a login, which you can register for on the site.

What renal artery endarterectomy involves

Renal artery endarterectomy is an open vascular operation performed by a specialist vascular surgeon. The goal is to remove the atherosclerotic plaque narrowing the renal artery, restoring blood flow to the kidney without creating a new conduit.

• Surgical access: A flank, retroperitoneal or midline transperitoneal incision exposes the renal artery at its origin from the aorta or along its course.
• Arterial control and heparinization: The surgeon clamps the renal artery above and below the diseased segment. Systemic heparin is given during the operation to prevent clotting while the artery is clamped.
• Arteriotomy: A longitudinal or transverse incision opens the arterial wall over the diseased segment, exposing the plaque.
• Plaque removal (endarterectomy): The surgeon dissects in the correct tissue plane to remove the atherosclerotic core and any calcified deposits from the vessel wall.
• Arterial closure: The arteriotomy is closed directly or with a vein or synthetic patch, to prevent narrowing at the closure site. If a patch is used, record it in the operative note and check the CCSD guidance before adding any separate line.
• Hemostasis and wound closure: Flow is restored, bleeding is controlled, and the wound is closed in layers.

This procedure differs from percutaneous transluminal renal angioplasty (PTRA) and renal artery stenting, which are catheter-based and need no open arteriotomy. In section 9.3.0, that work falls under L4300, Transluminal operations on renal artery. L4140 applies only when an open endarterectomy is performed and documented in the operative report.

Clinical indications: When L4140 applies

L4140 is appropriate when open endarterectomy is the chosen revascularization strategy for a patient with significant renal artery stenosis. The accepted clinical indications are:

• Atherosclerotic renal artery stenosis (RAS): Stenosis caused by plaque at or near the renal artery ostium, typically in patients over 55 with cardiovascular risk factors. This is the most common indication for L4140.
• Renovascular hypertension refractory to medical management: Persistent severe hypertension despite maximal antihypertensive therapy, attributable to hemodynamically significant renal artery stenosis.
• Ischemic nephropathy: Progressive renal impairment caused by reduced renal perfusion, where revascularization may preserve or improve kidney function.
• Bilateral renal artery stenosis or stenosis to a solitary functioning kidney: Where the risk of renal failure from continued under-perfusion outweighs the surgical risk.

Some findings point to a different procedure, and so a different code. Fibromuscular dysplasia often responds to PTRA. Severe chronic kidney disease may leave little function to recover. Plaque distribution can also make aorto-renal bypass the better option. Each of those alternatives carries its own CCSD code. Surgery on the artery of a transplanted kidney is billed under L4292 instead.

What L4140 includes and excludes

Knowing what sits inside L4140 prevents both under-billing and rejected invoices from stacked codes. The table below shows what the code covers, what other clinicians bill, and what needs a different code.

Neighboring CCSD codes in section 9.3.0 Renal

Section 9.3.0 Renal of the CCSD schedule holds four codes. Picking the wrong one is an easy way to get a renal revascularization invoice queried. For how the wider schedule is organized, see Pabau’s guide to Bupa CCSD codes. Three questions about the operative note, asked in order, settle which of the four applies.

The CCSD record for L4140 also cross-references L7010, Open embolectomy of artery, and L6710, Biopsy of artery (including temporal) (as sole procedure). Read the schedule’s coding guidance before you bill either one alongside L4140.

Confirm every code against the current CCSD schedule before you submit. The CCSD Group revises codes and descriptors over time, and an old code list is a common source of rejected invoices.

ICD-10 diagnosis codes to pair with CCSD code L4140

Every L4140 authorization request and invoice should name the diagnosis that justifies the surgery. Where an insurer asks for a coded diagnosis, use the WHO edition of ICD-10 that the UK uses, not the US ICD-10-CM. Check each code in the WHO ICD-10 browser.

Use the same diagnosis codes on the authorization request and on the invoice. A mismatch between the two is one of the easiest insurer queries to avoid.

Pre-authorization and documentation for L4140

Renal artery endarterectomy is planned inpatient surgery. UK private medical insurers generally expect the patient to get authorization before admission, and an admission without it may not be paid. Requirements differ by insurer and policy, so confirm them before the date is booked.

What the authorization request should carry

• Clinical justification: A letter or note from the vascular surgeon covering the diagnosis, the failure of medical management and the planned procedure, with L4140 cited.
• Supporting imaging: Duplex ultrasound, CT angiography or renal angiography showing the location and degree of the stenosis. Insurers differ on what they ask to see.
• Diagnosis codes: The same ICD-10 codes that will appear on the invoice, typically I70.1, I15.0 or N28.0.
• Admission details: The admission date, the hospital and the treating consultant.
• Authorization number: Once issued, quote it on every invoice for the admission. An invoice without it is a common and easily prevented reason for non-payment.

Documentation the billing file must contain

• Operative report: It must state the diagnosis, the surgical approach, the intraoperative findings, the endarterectomy technique and the closure method. The word “endarterectomy” must appear. A report describing only a bypass or a catheter-based procedure does not support L4140.
• Pre-operative imaging reports: Duplex ultrasound, CT angiogram or renal angiogram confirming the stenosis.
• Anesthesia record: The anesthetist bills separately, so both records should agree on the date and the procedure.
• Post-operative notes: Confirm the procedure was completed, and record any complications relevant to billing.
• Authorization record: The insurer’s authorization number, and any amendment made after the operation.

If the surgeon changes technique during the operation, for example converting to a bypass, tell the insurer afterwards. Have the authorization amended so it matches the code on the invoice.

How an L4140 claim moves from surgery to payment

One admission produces several invoices. The surgeon, the anesthetist and the hospital each bill for the same operation, so each needs the same code, diagnosis and authorization number.

1. Confirm the code: Check L4140 and its descriptor against the current CCSD schedule, and the fee against the insurer’s current schedule.
2. Link the diagnosis: Attach I70.1 as the primary diagnosis, plus I15.0 or N28.0 where they apply to this patient.
3. Quote the authorization number: Make sure the authorized procedure matches the code on the invoice.
4. Check the operative report: It must be finalized and signed before you submit. Never invoice from a dictated report that hasn’t been transcribed.
5. Submit electronically: Specialist invoices usually go through Healthcode or the insurer’s own portal. Check the insurer and policy details before sending.
6. Track the response: Follow up any query or short payment promptly, with the operative note and the authorization to hand.

Common reasons L4140 claims are queried or rejected

L4140 claims stall for a short list of repeating reasons. Each one can be caught before the invoice goes out.

Bilateral and combined procedures with L4140

CPT modifiers such as -50 don’t apply to CCSD codes. How bilateral or combined work is paid depends on the CCSD schedule’s guidance and on each insurer’s terms.

Bilateral procedures

When both renal arteries are cleared in one operation, check the insurer’s rules for a second procedure before you invoice it. Ask for an authorization that names both arteries, and keep a record of what the insurer confirmed. If a line is later short-paid, that record supports an appeal.

Concurrent vascular work

L4140 is sometimes performed within a larger vascular operation, such as an aortic endarterectomy. The CCSD guidance and the insurer’s terms decide whether both codes are payable. The operative report must describe each procedure separately to support more than one code.

Separately billed services

• Anesthetist: Invoices the anesthetic for the same operation.
• Assistant surgeon: May invoice an assistant’s fee where the insurer recognizes and pays one.
• Hospital: Bills its facility costs under its own agreement with the insurer.
• Post-operative care: If a different specialist manages the patient after surgery, that care is invoiced under the appropriate consultation code.

How Pabau keeps L4140 claims complete

A vascular surgery claim usually stalls on paperwork. The authorization sits in an email, the operative note sits in the hospital system, and the invoice is typed up days later.

Pabau keeps those pieces on one patient record. You record the patient’s insurance policy, the authorization number and the diagnosis alongside the consent forms and clinical notes. Pabau’s claims management then sends the invoice to UK insurers through Healthcode and Bupa.

The result is fewer insurer queries about missing details, so your vascular surgery work gets paid sooner.

Send complete vascular claims to UK insurers

Pabau keeps the CCSD code, ICD-10 diagnosis, authorization number and clinical notes on one patient record. Invoices go to UK insurers through Healthcode with every detail attached.

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Conclusion

L4140 is a narrow code. Bill it only when the surgeon opened the renal artery and cleared plaque from inside it, and the operative note says so.

The problems that hold up these claims sit around the code rather than in it. A missing authorization, a diagnosis that doesn’t match, or a reconstruction billed as L4140 will each stall payment. Settle all three before admission, and the insurer has little reason to query the invoice.

Book a demo to see how Pabau keeps each surgical invoice and its evidence on one patient record.

Continue your research

Need a broader view of how CCSD codes are structured? Bupa CCSD codes explains how the schedule’s chapters and code format work across procedure categories.

Billing an endarterectomy on a visceral artery instead? CCSD code L4530 covers endarterectomy and patch repair of a visceral branch of the abdominal aorta.

Billing renal artery work for a transplanted kidney? CCSD code L4292 covers reconstruction of the renal artery that supplies a transplanted kidney.

Was a biopsy taken from the artery as well? CCSD code L6710 explains when an arterial biopsy is billed as a sole procedure.

Frequently asked questions