CCSD code L6000 – Endarterectomy of femoral artery

Key takeaways

CCSD Code L6000 covers open surgical endarterectomy of the femoral artery, not endovascular treatment.

CCSD lists bypass codes L5910, L5923 and L5950, and graft revision L6530, as unacceptable combinations with L6000.

UK private medical insurers usually require pre-authorisation for elective femoral endarterectomy, tied to the procedure code and date.

Op reports missing the patch type, arteriotomy site or final scan are a common reason payers query L6000 claims.

Pabau’s claims management software submits L6000 claims through Healthcode and tracks authorisation and claim status.

CCSD Code L6000: official descriptor and clinical scope

CCSD Code L6000 is defined by the Clinical Coding & Schedule Development Group (CCSD) with the official descriptor: endarterectomy of femoral artery. CCSD maintains the procedure schedule that UK private insurers and hospitals use for claims. The code applies to open surgical endarterectomy, where the surgeon exposes the artery, opens it and removes the atherosclerotic plaque under direct vision. Endovascular procedures such as angioplasty, stenting and atherectomy have their own codes.

In anatomical terms, L6000 most commonly covers the common femoral artery (CFA), including the orifice of the profunda femoris (deep femoral artery). The superficial femoral artery (SFA) is its own vessel. When the surgeon extends the endarterectomy significantly into the SFA, coders should review the payer’s guidance before defaulting to L6000 alone.

The CCSD technical guide sets out the business rules for how codes in the schedule are structured, combined and reported. Review the current version before filing L6000 claims. For other procedures, our reference list of CCSD codes covers each code in the same format.

Clinical indications and supporting ICD-10 diagnosis codes

Peripheral arterial disease (PAD) with haemodynamically significant stenosis or occlusion of the common femoral artery is the primary indication for L6000. Payers assess medical necessity against their own clinical criteria, which can include ankle-brachial index (ABI) measurements, duplex ultrasound or CTA findings, and Rutherford stage. An ICD-10 code that understates the severity in the operative report (op note) puts the claim at risk.

CCSD claims pair with WHO ICD-10, in the UK version, which records leg atherosclerosis at the I70.2 category level. Laterality-specific codes such as I70.211 belong to the US ICD-10-CM. The table shows them only as ICD-10-CM examples, and they do not go on a UK CCSD claim.

Payers may set clinical thresholds, such as an ABI cut-off or a duplex stenosis grade, in their own pre-authorisation criteria. Record the measured values in the pre-operative and op notes so the reviewer can check them against those criteria.

What L6000 includes and excludes: bundled vs separately billable services

Knowing what the L6000 fee covers by default prevents both undercoding and unbundling. The table below summarises the position for common accompanying procedures. Payer rules take precedence over general guidance, so confirm with the payer before adding a second code.

The chart below sorts those items into three groups, so a coder can check each extra line in the op note before filing.

Neighbouring CCSD codes: choosing the right code for femoral artery procedures

Several CCSD codes sit close to L6000 in the vascular chapter. Choosing the wrong one is a common error when the op note describes several arterial segments, or a mix of open and endovascular work. The Bupa CCSD procedure codes guide shows how Bupa applies vascular codes in practice.

Catheter-based treatment of the femoral artery is coded as L6300, not L6000. When the op note describes a femoral endarterectomy alongside a bypass, check the bypass code against the barred pairings first. Payers apply the same check to every multi-code claim on one date of service.

Bilateral, multiple-procedure and assistant rules for L6000

CCSD does not publish modifiers or payment percentages for L6000. Each payer sets its own rules for bilateral surgery, several procedures and assistants in its fee schedule, so check that schedule before you submit.

• Bilateral procedures: Bilateral femoral endarterectomy is uncommon but does occur. Record each side explicitly in the op note, and check how the payer pays the second side.
• Assistant surgeon: Femoral endarterectomy often needs an assistant for retraction and exposure of the femoral triangle. Confirm whether the payer pays an assistant fee with L6000, and on what basis.
• Multiple procedures: When L6000 is claimed with another code the payer accepts, its multiple-procedure rule sets the payment for the second procedure. CCSD barred pairings cannot be claimed together at all.
• Two consultants operating together: Some complex reconstructions involve two consultant surgeons operating at the same time. Confirm the payer’s rules before both surgeons submit a claim.

Documentation requirements for L6000 femoral endarterectomy claims

Payers auditing L6000 claims focus almost entirely on the op report. A thin or ambiguous op note is the fastest route to a query or a medical necessity review. The checklist below covers the elements coders should confirm before filing the claim.

• Arteriotomy site and length: The note must name the segment opened (common femoral artery, profunda femoris orifice, or extension into the SFA). It should also give the arteriotomy length in centimetres or as a clinical range.
• Plaque description: Describe the plaque removed, including its character (soft, calcified, friable), its extent and the endpoint of the endarterectomy plane. This supports both the procedure code and the ICD-10 code.
• Closure method: State clearly whether the artery was closed primarily (direct suture) or with a patch. If a patch was used, specify the type: autogenous vein, Dacron, bovine pericardium or other synthetic material. This detail decides whether an extra patch angioplasty code may be appropriate.
• Final scan: If intraoperative duplex ultrasound or final arteriography was performed, record it on its own in the op note. This supports any separate scan claim the payer allows.
• Anaesthesia type: Record whether general anaesthesia, regional anaesthesia (spinal or epidural), or a peripheral nerve block was used. Anaesthesia is billed apart from L6000, but the anaesthesia record must match the op note.
• Estimated blood loss and operative time: Payers use these standard items to corroborate procedural complexity.

Prior authorisation and payer requirements

Elective femoral endarterectomy usually needs pre-authorisation from the patient’s UK private medical insurer, such as Bupa, AXA Health, Aviva, Vitality or WPA. Filing without an authorisation number is an easy denial to prevent. It still happens when administrative teams assume an existing authorisation covers another procedure or surgical date.

Payers’ pre-authorisation teams typically ask for ABI results, duplex ultrasound or CT angiography findings, and the Rutherford stage. Most also want a referral letter from the consultant vascular surgeon. Urgent endarterectomy for acute femoral occlusion (ICD-10 I74.3) may be authorised retrospectively. Check the payer’s urgent-case process before filing.

CCSD itself does not set fees or decide cover. As the CCSD FAQs explain, each payer sets its own fees and decides which codes it covers. The payer reviews the clinical evidence against its own protocol for peripheral vascular disease before issuing an authorisation number.

Common claim denial reasons for L6000 and how to prevent them

L6000 claim denials cluster around four root causes, and each one can be caught at the point of coding, before filing.

Billing L6000 in practice: workflow for vascular surgery coders

A consistent step-by-step workflow reduces coding errors and shortens the claim lifecycle from op note to payment. The following sequence applies to standard elective L6000 filings.

1. Receive and review the op note. Confirm the procedure was an open endarterectomy of the femoral artery. Check for the six items in the checklist above, and return the note to the surgeon for an addendum if any are missing.
2. Select CCSD Code L6000. Check it is the correct code for the arterial segment described. If the note extends significantly into the SFA or iliac segment, review the payer’s guidance or ask your coding manager before defaulting to L6000 alone.
3. Assign supporting ICD-10 diagnosis codes. Match the most specific WHO ICD-10 code to the clinical presentation, such as PAD or acute occlusion. Link the ICD-10 code directly to L6000 on the claim.
4. Check for additional codes. Remove any CCSD barred pairing, such as L5910, L5923, L5950 or L6530. Then confirm the payer’s rules for patch angioplasty or intraoperative scan before adding either code.
5. Apply the payer’s billing rules. Check its rules for bilateral surgery, assistants and multiple procedures.
6. Verify prior authorisation. Confirm the authorisation number is valid for L6000, for this patient, on this date of service.
7. Scrub and submit the claim. Cross-check the claim against the payer’s rules, then submit electronically where the payer supports it.

How Pabau tracks L6000 authorisations and claims

Without a central record, pre-authorisation numbers end up in emails and spreadsheets. A claim can then go out against an authorisation for another date or procedure, and the payer returns it.

Pabau, the practice management platform we build, submits payer claims through Healthcode and tracks the status of each one. Its claims management software also records the pre-authorisation status against the booked procedure. Coders can confirm the authorisation matches L6000 and the surgery date before the claim goes out.

Clinical notes sit in the same patient record. A coder can check the op note for a missing patch type and send it back to the surgeon before filing.

Manage CCSD vascular billing from one platform

Pabau’s claims management tools help vascular surgery practices submit L6000 claims through Healthcode and track authorisation and claim status in one place.

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Conclusion

L6000 claims succeed or fail on the checks made before filing. Hold the op note to the documentation checklist, drop any CCSD barred pairing, and match the authorisation number to the code and the surgery date.

The trade-off is a few extra minutes at the coding stage. A surgeon addendum before filing is quicker than an appeal after the payer has returned the claim.

Pabau keeps the operative record, the authorisation status and the Healthcode claim in one system. Book a demo to see how it fits your vascular billing workflow.

Continue your research

Need to see how one payer applies CCSD codes? Bupa CCSD codes overview explains how Bupa applies CCSD procedure codes, including vascular surgery filings.

Coding catheter-based work on the femoral artery? CCSD code L6300 covers transluminal procedures on the femoral artery and how they differ from open surgery.

Looking up another procedure in the schedule? CCSD codes lists our guides to individual CCSD procedure codes.

Want fewer returned claims across your surgical practice? Pabau claims management submits claims through Healthcode and tracks authorisation and claim status.

Frequently asked questions