CCSD code L5910 – Femorofemoral bypass surgery

Key takeaways

CCSD code L5910 covers femoro-femoral bypass, a crossover graft that carries blood from one groin to the other across the lower abdomen.

The operation depends on a healthy donor iliac artery. When both iliac arteries are diseased, an axillo-femoral code such as L1620 or L1680 fits instead.

L5910 sits in chapter 9.5.0 Ileo-femoral Vessels of the CCSD Schedule, under reference FI.035.

CCSD lists L6000, L6300, L6530, L6710, L7010 and L9350 as unacceptable combinations with L5910.

UK private medical insurers such as Bupa, AXA Health, Aviva and Vitality generally expect pre-authorization before planned vascular surgery.

Pabau, our practice management software, sends CCSD claims to UK insurers through Healthcode from the record that holds the authorization and operative note.

CCSD code L5910: What the descriptor covers

CCSD code L5910 is the procedure code for femoro-femoral bypass in the schedule of the Clinical Coding and Schedule Development (CCSD) Group. That group represents four major UK private medical insurers. The surgeon tunnels a graft under the skin from one common femoral artery to the other. Blood then flows from the healthy side to the leg starved by iliac disease.

Aviva, AXA Health, Bupa and Vitality sit on the group, and Healthcode uses the same schedule to route claims. It lists L5910 under reference FI.035, in chapter 9.5.0 Ileo-femoral Vessels within 9.0.0 Vascular System. Our CCSD procedure code library covers the other codes in the schedule.

The key billing facts at a glance:

The femoro-femoral bypass: What it involves

A femoro-femoral bypass is an extra-anatomic operation. The graft runs under the skin of the lower abdomen rather than along the path of the iliac arteries. Because it avoids the abdomen and the aorta, surgeons can offer it to patients who would not tolerate aortic surgery. The schedule codes other extra-anatomic routes in their own sections. A carotid-to-subclavian graft that stays in the neck, for example, is CCSD code L3711.

Coders should be able to find these elements in the operative note:

1. Groin exposure on both sides: The surgeon opens both groins to expose the common femoral arteries. The note should say which side is the donor and which is the recipient.
2. Donor inflow: The donor iliac artery must carry good flow, because it now supplies both legs. Pre-operative imaging should confirm it.
3. Tunnel: The graft crosses in a subcutaneous tunnel above the pubic bone, usually in a gentle inverted-U shape.
4. Conduit: A prosthetic graft (PTFE or Dacron) is the usual choice. The note records the material and diameter.
5. Anastomoses: Both ends are sewn onto the femoral arteries, and the note records each site.
6. Completion check: Doppler signals, pulses or completion imaging confirm that the graft is patent.

If the note describes a graft from the axillary artery, or an incision in the abdomen to reach the aorta, L5910 is the wrong code. Read the inflow vessel again before choosing.

Clinical indications: When is L5910 used?

Surgeons choose a femoro-femoral bypass when one iliac artery is blocked and the other is healthy. The common indications are:

• Unilateral iliac occlusion or severe stenosis: Imaging shows a blocked iliac artery on one side and a patent donor iliac on the other.
• Chronic limb-threatening ischemia: Rest pain, ulcers or gangrene in the leg on the blocked side.
• Disabling claudication: Walking pain that limits daily life after supervised exercise and risk-factor treatment.
• High surgical risk: Heart or lung disease, or a hostile abdomen from earlier surgery, that rules out an aortic bypass.
• Failed or unsuitable iliac stenting: A long occlusion that a stent cannot cross, or a stent that has blocked again.
• Occluded limb of an aortic graft: One limb of an earlier aorto-bifemoral graft has blocked while the other still runs.

A crossover graft placed as part of an aorto-monoiliac endovascular aneurysm repair is a different case. CCSD code L2760 already covers the stent graft with its crossover bypass, so L5910 is not added.

CCSD code L5910 vs the neighboring bypass codes

Three questions settle the code. Where does the graft take its inflow, where does it end, and is a graft placed at all? The CCSD Schedule entries below are the ones most often confused with L5910.

Common mis-coding scenario: The operative note describes bilateral iliac disease, but the claim carries L5910. A crossover graft needs a healthy donor iliac, so bilateral disease usually points to CCSD code L1680, axillo-bifemoral bypass. Check the inflow vessel in the note before the claim goes out.

A single-groin axillary graft is CCSD code L1620 instead. Both axillo-femoral codes sit in chapter 9.4.0 Abdominal Vessels, not beside L5910 in 9.5.0. Sorted by inflow vessel, the choice comes down to four rows.

What the code includes and excludes

The CCSD Technical Guide sets a single-code principle. One code describes the procedure from start to finish, including its routine parts and the care around it.

Included within L5910:

• Exposure of both common femoral arteries
• Tunneling of the graft and both anastomoses
• Intraoperative Doppler or completion imaging in the same session
• Wound closure in both groins

CCSD also lists six unacceptable combinations with L5910, so none of them belongs on the same claim:

• L6000: Endarterectomy of femoral artery
• L6300: Transluminal procedures on femoral artery
• L6530: Revision of femoral bypass graft
• L6710: Biopsy of artery (including temporal) (as sole procedure)
• L7010: Open embolectomy of artery
• L9350: Basilic vein transposition

The guide calls these lists guidelines that are not comprehensive, and each insurer sets its own contract rules for multiple codes. Ask the insurer before submitting a second procedure code from the same operation.

The CCSD Schedule has no modifiers for laterality or assistants. L5910 already involves both groins, so it is never billed twice for one operation. Whether an assistant surgeon or graft material is paid separately depends on the insurer, so check its fee rules first.

Documentation requirements for an L5910 claim

UK private insurers decide L5910 claims on the operative note and the imaging behind it. A note that leaves out the donor side invites an information request, or a query about whether an axillo-femoral code applies instead.

The operative note should confirm all of the following:

1. Donor and recipient sides: Which femoral artery supplies the graft and which one receives it.
2. Donor iliac patency: The duplex, CT angiography or MR angiography finding that shows the donor side is healthy.
3. Indication: The diagnosis on the blocked side, with the imaging that supports it.
4. Conduit: The graft material and diameter.
5. Anastomoses and tunnel: Both anastomosis sites and the route of the tunnel.
6. Completion assessment: The Doppler, pulse or imaging check that confirmed graft patency.

Insurers may also ask for the discharge summary and the imaging report behind the decision to operate. Keeping them beside the operative note lets the billing team answer a query the same day.

Pre-authorization: What UK private insurers require

UK private medical insurers generally require pre-authorization before planned surgery, and an arterial bypass falls in that group. Bupa’s claims guidance asks members to call before treatment, then issues a pre-authorization code for the specialist. The code on the claim should match the code that was authorized.

A pre-authorization request for L5910 usually includes:

• The CCSD code L5910 and the planned date of surgery
• The ICD-10 diagnosis and a short clinical summary
• Imaging that confirms the iliac occlusion and a healthy donor side
• The reason a crossover graft was chosen over stenting or an aortic bypass, where that applies
• The surgeon’s insurer recognition details and the hospital

Check each insurer’s requirements on its own provider portal. Our guide to Bupa CCSD codes explains how to look a code up against Bupa’s schedule.

Acute limb ischemia is an emergency, and emergencies go to the NHS. AXA Health says private health insurance does not usually cover emergency care. Private cover may apply to follow-up treatment once the NHS has handled the emergency.

Submitting the claim through Healthcode

Healthcode is the main electronic billing route for UK private healthcare. A typical L5910 claim follows these steps:

1. Open the claim against the patient’s episode and confirm the insurer, membership number and pre-authorization number.
2. Enter L5910 as the procedure code. Check the unacceptable combinations before adding any second code.
3. Add the ICD-10 diagnosis that the operative note and imaging support.
4. Validate and submit. Healthcode checks the claim before it reaches the insurer, so fix any flagged field first.
5. Track the response and answer any information request inside the insurer’s deadline.

ICD-10 codes commonly paired with L5910

UK insurers expect a WHO ICD-10 diagnosis that explains why the bypass was needed. The WHO ICD-10 browser confirms each descriptor. The pairings below are illustrative, and the surgeon’s documented diagnosis decides the code.

Embolism and thrombosis of the iliac artery is ICD-10 code I74.5, not I74.3. I74.3 is reserved for the arteries of the leg itself. The diagnosis should name the same side and lesion that the imaging report describes.

Common reasons L5910 claims are denied

Most L5910 denials trace back to the authorization, the code choice or the operative note. The table pairs each trigger with its fix.

Send any appeal inside the deadline the insurer sets, with the corrected note or authorization attached.

How Pabau keeps L5910 claims matched from authorization to payment

In many practices the authorization, the operative note and the claim live in three places. The secretary logs the authorization number in one system, and the surgeon dictates the note into another. The billing team rebuilds the claim days later, which is when crossover and axillo-femoral codes get swapped.

Pabau holds those steps in one patient record. The authorization code, its dates and approved sessions sit on the patient’s case, and Pabau warns the team when one is missing. Through its authorization-matched claims management, Pabau sends each claim to UK insurers through Healthcode or straight to Bupa.

The outcome is fewer information requests to chase and a shorter wait between surgery and payment. Core features come with every plan, so billing and patient records sit together from day one.

Keep CCSD claims matched to the operative note

Pabau sends CCSD claims through Healthcode from the same record that holds the authorization code and operative note. Your vascular team spends less time answering insurer queries.

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Conclusion

For L5910, the donor iliac decides the claim. A note that shows one blocked iliac, a healthy donor side and a graft across both groins supports L5910. Bilateral iliac disease points to an axillo-femoral code, and an aortic inflow points to L5100 or L5180.

The fix sits before billing starts. Agree a note template with your vascular surgeons that records the donor side, the tunnel and the conduit every time. Then confirm the authorized code matches the planned operation before the surgical schedule is final.

Book a demo to see how Pabau keeps authorizations, operative notes and Healthcode claims for CCSD vascular codes in one record.

Continue your research

Coding a bypass that runs below the knee? CCSD code L5950 covers femoro-distal calf bypass with a prosthesis and the detail insurers check.

Billing open surgery on the iliac artery itself? CCSD code L5300 explains open operations on the iliac artery for UK private billing.

Repairing a limb artery with a vein graft? CCSD code L6840 walks through the documentation and claim for that repair.

Frequently asked questions