CCSD code L7423 – Ligation of arteriovenous fistula for dialysis

Key takeaways

CCSD code L7423 covers surgical ligation of an arteriovenous fistula created for haemodialysis access, in chapter 9 of the UK CCSD schedule.

Accepted indications include steal syndrome, high-output cardiac failure, a large aneurysm, irreversible thrombosis and dialysis independence after a kidney transplant.

Pair L7423 with ICD-10 code I77.0 (arteriovenous fistula, acquired) as the primary diagnosis, then add a secondary code for the indication.

L7423 is graded Intermediate. Freedom Health Insurance lists a £200.00 specialist fee and a £213.00 anaesthetist fee, and other insurers set their own.

UK private medical insurers expect treatment to be pre-authorised, so get the authorisation number before surgery and put it on every invoice.

CCSD Code L7423: Definition and scope

CCSD Code L7423 is the Clinical Coding & Schedule Development code for Ligation of arteriovenous fistula for dialysis. It sits in the L-series of the CCSD schedule, which covers vascular surgery.

The schedule is maintained by the CCSD Group, whose members are four insurers: Bupa, AXA Health, Aviva and VitalityHealth. Together they set the standard procedure codes for UK private healthcare. Our CCSD code library lists the wider schedule.

The code applies to the deliberate, operative ligation of a fistula that was created for haemodialysis access. It does not cover creating or revising a fistula. Nor does it cover an arteriovenous fistula caused by trauma or a congenital anomaly. The procedure code and the ICD-10 diagnosis codes on the invoice must both reflect this.

The fees belong to each insurer, because CCSD maintains the codes rather than the prices. Bupa publishes its own surgeon and anaesthetist benefit limits in its Schedule of Procedures. Our Bupa fee schedule guide shows how one insurer prices each code.

What the L7423 procedure involves

Ligation of an arteriovenous fistula is a vascular procedure performed under local, regional or general anaesthesia. The surgeon exposes the fistula at the wrist, forearm or upper arm, depending on how it was built. Blood flow through the fistula is then interrupted by ligating the arterial inflow, the venous outflow or both.

For the invoice to be defensible, the operative note must record the site accessed and exactly how the ligation was done. It should also say whether the fistula was tied at one point or at several. A note that says only “AV fistula ligated” is a common trigger for an insurer query.

Who performs L7423 and in what setting

L7423 is billed by a consultant vascular surgeon, or another consultant surgeon whose practice includes dialysis access. In the UK the surgeon must be registered with the General Medical Council (GMC). Each insurer also has to recognise the consultant before it will settle their invoice.

• Setting: Usually a day case or a short stay in a private hospital theatre, often under local or regional anaesthesia.
• Anaesthetist: When an anaesthetist takes part, they invoice separately under the same CCSD code at the insurer’s anaesthetist fee.
• Elective or urgent: A planned ligation after a kidney transplant is elective. Limb-threatening steal or bleeding is urgent, which affects whether an insurer will fund it, as the pre-authorisation section explains.

Clinical indications: When is ligation of an arteriovenous fistula performed?

Insurers expect a documented clinical indication before they authorise or pay an L7423 invoice. Each indication below is accepted in vascular surgery and nephrology practice. The pre-operative assessment must record it, and the operative note must refer to it.

• Dialysis access steal syndrome (DASS): The high-flow fistula diverts blood away from the distal limb, causing ischaemic pain, numbness or tissue loss. Steal is the most common urgent indication for ligation.
• High-output cardiac failure: A high-flow fistula raises cardiac output over time. Where the fistula is identified as the cause of decompensated cardiac failure, ligation is a recognised treatment.
• Aneurysmal dilatation at risk of rupture: A large, expanding aneurysm of the fistula vein may not be safely repairable. In that case, ligation of the feeding vessel is justified.
• Irreversible thrombosis: A chronically thrombosed fistula that can’t be salvaged by thrombectomy or revision, and that causes local complications, may be ligated.
• Successful kidney transplant: When a functioning transplant leaves the patient free of dialysis, the fistula may be ligated electively to remove its haemodynamic burden.
• Withdrawal from dialysis: A patient may choose to stop dialysis, or someone legally entitled to decide for them may do so. Ligation can then form part of palliative care planning.

What L7423 includes and excludes

Billing components that are part of L7423 cannot be invoiced separately. Procedures outside it need their own CCSD codes.

Creating a new fistula and ligating the old one in the same session is possible, for example when access moves to another site. Both codes may then be billed, but the insurer’s multiple-procedure rule applies. Pre-authorise both procedures and record why both were needed at once.

Related and neighbouring CCSD codes

L7423 sits among the CCSD codes for arteriovenous fistula and shunt surgery. Choosing the wrong one is the most common error in vascular access billing. The decision path below sorts them by what the operation did to the fistula.

The descriptors and grades above come from the Freedom Health Insurance chapter 9 schedule, updated August 2026. Check the current CCSD schedule and the Bupa code search tool before you invoice.

ICD-10 diagnosis codes to pair with L7423

UK insurers expect an ICD-10 diagnosis code alongside the CCSD procedure code. The codes below map to the clinical indications for L7423. Check each one against the WHO ICD-10 edition used in the UK, not the US ICD-10-CM.

Use I77.0 as the primary diagnosis on every L7423 claim. The secondary code should reflect the clinical indication that led to the decision to ligate. A secondary code that doesn’t match the documented indication is a common cause of an insurer query.

Billing rules for CCSD code L7423

CCSD codes carry no modifiers. The rules that change what an L7423 invoice pays come from the CCSD technical guide and from each insurer’s fee schedule.

Pre-authorisation for L7423 with UK private medical insurers

UK private medical insurers expect treatment to be pre-authorised before it starts. The patient usually contacts their insurer with the code and its description. The insurer then issues an authorisation number, which goes on every invoice.

Private medical insurance generally covers acute conditions rather than the ongoing management of chronic ones. Kidney failure that needs dialysis is chronic, so confirm the policy covers the fistula complication before you book theatre. Where the insurer declines, the patient can still choose to fund the ligation themselves.

Elective ligation

For elective ligation after a transplant, or for planned steal or aneurysm treatment, send the insurer:

• A clinical summary from the vascular surgeon that names the indication and confirms conservative management was considered or tried.
• Doppler ultrasound or angiography findings showing the fistula’s haemodynamic status. For steal syndrome, flow measurements and distal Doppler waveforms are standard.
• The CCSD code (L7423) and its description, with the paired ICD-10 diagnosis code.
• Confirmation that the patient’s policy covers the procedure at the chosen hospital.

Urgent ligation

Urgent ligation for acute limb-threatening steal, or for bleeding from a ruptured aneurysm, is harder to fund privately. Most UK insurers leave emergency treatment to the NHS. Where an urgent case is treated privately, contact the insurer before surgery if you can, and record the authorisation number.

Documentation requirements for a defensible L7423 claim

Insurers that query L7423 invoices look for a clear chain of clinical evidence, from the decision to ligate to the operative report. Use this checklist before you invoice.

• Named procedure: The operative note must name “ligation of arteriovenous fistula” to match the CCSD descriptor, rather than a generic “vascular access surgery.”
• Anatomical site and laterality: Record the right or left limb and the specific site, such as radial-cephalic, brachial-cephalic or brachial-basilic.
• Pre-operative indication: The clinical indication in the pre-operative assessment must match the ICD-10 code on the claim.
• Surgical technique: Record whether ligation was at the arterial inflow, the venous outflow or both, the suture material, and any intraoperative Doppler findings.
• Surgeon identity: Full name, GMC number and specialty of the operating surgeon.
• Complications encountered: Note any intraoperative complications. Any that needed extra procedures must reference those procedures’ own CCSD codes.
• Post-operative plan: Confirm that no further vascular access is planned on the same limb, which matters after a post-transplant ligation.

Common denial reasons for CCSD Code L7423 claims

L7423 denials cluster around a small set of correctable errors. Catching them while the invoice is prepared keeps rejections down.

Our Bupa CCSD codes guide explains how Bupa handles CCSD claim submissions in more detail.

How Pabau supports L7423 billing through Healthcode

Vascular billing teams often track a fistula ligation across clinic letters, theatre notes and insurer portals. The authorisation number and the indication easily end up separated from the invoice that needs them.

Pabau, the practice management software we build for private practices, keeps the CCSD code, the ICD-10 diagnosis and the authorisation number on one claim record. You submit the claim through Healthcode and track its status in the same place.

Our claims management software also lets you attach insurer billing notes to the record, such as a multiple-procedure rule. Pabau doesn’t choose the code for you, so the checks above still apply.

Send complete CCSD claims to UK insurers

Pabau keeps the CCSD code, ICD-10 diagnosis and authorisation number on one claim record, then submits it through Healthcode. See how it fits your vascular billing workflow.

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Conclusion

L7423 fits one operation: deliberately closing a fistula that was built for dialysis. A fistula created under L7420 already includes its closure, and a repair that keeps the fistula working belongs to L7520 or L7580.

For UK private billing, cover is the harder question. Kidney failure is a chronic condition, and urgent fistula complications often fall to the NHS. A funded L7423 claim rests on authorisation before surgery and a pre-operative note that names the indication.

Settle the code, the diagnosis and the authorisation number before the invoice leaves the practice. To see how Pabau keeps the whole claim in one place, book a demo.

Continue your research

Is the fistula being repaired rather than closed? CCSD code L7520 covers repair of an acquired arteriovenous fistula and the documentation insurers expect for it.

Coding open aortic surgery as well as access work? CCSD code L1960 covers an infrarenal aortic aneurysm repair with a bifurcation graft.

Coding a leaking aneurysm higher up the aorta? CCSD code L1880 sets out the arch repair code, its ICD-10 pairing and its pre-authorisation rules.

Frequently asked questions