CCSD code M1400 – Extracorporeal kidney stone lithotripsy

Key takeaways

CCSD code M1400 covers extracorporeal shock wave lithotripsy (ESWL) of a kidney stone, billed as one unit per treatment session.

The CCSD schedule has no separate repeat-session code, so every further ESWL session is another M1400 that needs the insurer’s authorisation first.

ESWL of a ureteric stone is M3110, and endoscopic or percutaneous kidney stone surgery takes M0910 or M0940.

UK private insurers such as Bupa, AXA Health, Aviva and Vitality expect a pre-authorisation number before the session goes ahead.

N20.0 (calculus of kidney) is the cleanest ICD-10 pairing, with N20.2 used when a ureteric stone is also present.

What is CCSD code M1400?

CCSD code M1400 is the UK private-sector procedure code for extracorporeal fragmentation of calculus of kidney (lithotripsy), billed per single treatment. It covers extracorporeal shock wave lithotripsy (ESWL) of a renal stone, where the shock waves are generated outside the body.

CCSD stands for Clinical Coding and Schedule Development, the group that maintains the procedure and diagnostic test schedule used across UK private healthcare. Bupa, AXA Health, Aviva and Vitality back the schedule, and insurers such as WPA, Cigna, Allianz Care and Healix use it too.

Within the full set of CCSD codes, M1400 sits in Chapter 12, which covers the urinary system and male reproductive organs.

The word “extracorporeal” is what separates M1400 from ureteroscopic and percutaneous stone surgery, which carry their own CCSD codes. The words “single treatment” set the billing unit: one M1400 equals one ESWL session on one date.

How extracorporeal lithotripsy works

ESWL focuses acoustic shock waves on a kidney stone from outside the body, breaking it into fragments small enough to pass in the urine. Insurers audit M1400 claims against the procedure note, so each stage below should appear in it.

• Positioning and localisation: The patient lies on the lithotripter table, and the stone is located with fluoroscopy or ultrasound. Imaging confirms the stone sits at the shock wave focal point.
• Shock wave delivery: A series of shock waves is delivered over roughly 30 to 60 minutes. The shock count and energy setting go into the procedure note.
• Fragmentation monitoring: Imaging tracks fragmentation during the session. A post-treatment KUB X-ray or ultrasound records the result and any residual stone.
• Recovery and discharge: The patient is monitored for haematuria, pain and stable observations before going home. An outcome note completes the record.

Clinical indications for kidney ESWL

M1400 applies when the consultant urologist chooses ESWL as the treatment for a stone in the renal pelvis or calyces. Typical candidates have stones under about 20 mm whose CT density suggests they will fragment.

The code is site-specific. A stone treated by ESWL in the ureter is coded M3110, and bladder stones have their own codes. Where both a kidney and a ureteric stone are treated in one sitting, check the insurer’s multiple-procedure rules before billing both codes.

ICD-10 diagnosis codes to pair with M1400

UK insurers ask for the diagnosis when they authorise and pay a claim, and recording it as an ICD-10 code keeps it unambiguous. The pairings below come from the WHO ICD-10 classification, which UK coders look up in the NHS Classifications Browser.

When in doubt, N20.0 is the most defensible primary diagnosis for a straightforward renal stone treated by ESWL. The diagnosis on the claim should match the one given at authorisation.

Codes commonly confused with M1400

The access route and the stone’s location decide the code, as the chart below shows. The table after it sets M1400 against the stone codes it is most often mixed up with, using the descriptors in the current CCSD schedule.

Our guide to CCSD code M0910 covers the endoscopic route in detail. Check descriptors against the current schedule each year, because CCSD revises codes in regular updates.

Understanding the single treatment rule

One M1400 covers one ESWL session on one date of service. The CCSD schedule has no add-on code for repeat kidney ESWL, so the rule plays out as follows.

• Several stones in one session: Treating two calyceal stones in the same kidney during one sitting is still one treatment. Bill one M1400.
• Session paused and resumed the same day: A break for patient comfort does not create a second treatment. Two M1400 units on one date will be queried.
• Repeat session for residual fragments: A second session on a later date is billed as M1400 again. Confirm the authorisation covers it before booking, since insurers often authorise a set number of sessions.
• Both kidneys treated: ESWL is usually done on one side per session. If both sides are treated in one sitting, apply the insurer’s multiple-procedure rules and confirm with the insurer first.

Pre-authorisation requirements from UK private insurers

UK private medical insurers generally expect a pre-authorisation number before ESWL goes ahead. The patient usually calls the insurer with their referral to get it, though many consultants’ secretaries help. Treatment without authorisation risks the insurer declining the claim, leaving the patient to pay.

An authorisation request for M1400 typically covers the following details.

• The CCSD code (M1400) and the diagnosis, ideally with its ICD-10 code
• An imaging report confirming stone size, location and density (CT KUB, KUB X-ray or ultrasound)
• The consultant’s name and the provider number the insurer holds for them
• The hospital or lithotripsy unit and the planned date of treatment
• The number of sessions the consultant expects to need

Our Bupa CCSD codes guide walks through Bupa’s authorisation and submission steps. Other insurers follow a similar pattern, but confirm the details with each one.

Documentation requirements for a valid M1400 claim

A valid M1400 claim rests on records that show the session happened as billed and was clinically indicated. Practices using claims management software can keep these documents on the patient record next to the claim.

• Pre-treatment imaging: A dated CT KUB or KUB X-ray confirming the stone’s size, density and renal location.
• Authorisation number: The insurer’s reference, recorded on the invoice with the date it was granted.
• Procedure note: Confirms extracorporeal delivery, imaging-guided localisation, the date, the shock count and the treating consultant.
• Imaging guidance record: The fluoroscopy or ultrasound note from the session itself.
• Post-treatment note: Records the degree of fragmentation, any residual stone, discharge status and the follow-up plan.
• Anaesthetic record: Needed when an anaesthetist gave sedation or general anaesthesia, since the anaesthetist bills separately.

Bundling rules: What can and cannot be billed alongside M1400

Imaging guidance during the session is part of M1400 and is not billed as a separate code. A diagnostic scan done before the treatment day, such as a CT KUB, is a separate investigation billed by whoever performed it.

Anaesthesia needs a check per insurer. H3 Insurance’s fee schedule, for example, marks M1400 as a procedure whose fee already includes any local anaesthesia or sedation. Where an anaesthetist gives a general anaesthetic, they invoice the insurer on their own claim.

The hospital or lithotripsy unit invoices the insurer separately for the facility, equipment and consumables. The consultant’s M1400 invoice covers only the professional fee, and folding facility charges into it will be rejected.

Why M1400 claims get denied

Most M1400 rejections from UK insurers trace back to authorisation, policy cover or coding. The causes below are the ones to check before an invoice goes out.

• No authorisation, or the wrong one: The session went ahead without a pre-authorisation number, or the number covers fewer sessions than were billed.
• Policy exclusion: Under moratorium underwriting, a patient with kidney stones in the years before joining may find the condition excluded.
• Wrong anatomical code: Billing M1400 for a stone that was in the ureter, which is M3110.
• Unspecified diagnosis: N20.9 sent where imaging showed a renal stone, prompting a query and a delay.
• Consultant details mismatch: The provider number on the invoice differs from the one on the authorisation. A consultant the insurer does not recognise is also rejected.
• Duplicate units: Two M1400 units on one date of service for what was a single session.
• Fee above the insurer’s schedule: The insurer pays up to its own fee for M1400. Any shortfall falls to the patient, who should hear about it before treatment.

How to resolve a rejected claim

A rejected M1400 claim can usually be put right, and the route depends on why it was declined. Work through these steps in order.

1. Read the rejection reason: Check the insurer’s remittance or Healthcode message to see whether the issue is authorisation, cover, coding or missing records.
2. Correct and resubmit coding errors: A wrong code, diagnosis or provider number is usually fixed by amending the invoice and sending it again.
3. Send records for clinical queries: The consultant writes to the insurer with the imaging, the procedure note and the reason ESWL was chosen.
4. Escalate cover decisions through the patient: The policyholder complains to the insurer first. If the final response does not settle it, or eight weeks pass, they can refer it to the Financial Ombudsman Service.
5. Settle any shortfall with the patient: Where the insurer pays less than the invoice, explain the difference before billing the patient for it.

How Pabau keeps M1400 claims clean from authorisation to payment

Lithotripsy billing goes wrong when the code, the diagnosis and the authorisation number live in different places. Pabau keeps them on one patient record from booking to invoice.

Your team records M1400 with its ICD-10 diagnosis and the insurer’s authorisation number on the appointment. The invoice then goes to Bupa, AXA Health and other insurers through Healthcode, so the details the insurer checks arrive together.

Each ESWL session sits on its own dated appointment, so a repeat session is easy to match against the number of sessions authorised. That makes it harder to bill a session the insurer has not agreed to pay.

Get M1400 claims paid the first time

Pabau helps UK private urology practices record CCSD codes, ICD-10 diagnoses and authorisation numbers. Claims then go through Healthcode to Bupa, AXA Health and other insurers.

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Conclusion

Every M1400 claim turns on two facts. The ESWL session treated a stone in the kidney, and the insurer authorised that session first. Get both right and most rejections disappear.

Repeat sessions are where practices lose money, because each one is a fresh M1400 that needs cover in place. Track sessions against the authorisation, not from memory. Book a demo to see how Pabau links each lithotripsy session to its CCSD code and authorisation.

Continue your research

Need the full picture of Bupa CCSD billing? Pabau’s Bupa CCSD codes guide covers code structure, authorisation and submission for UK private practice.

Coding other endoscopic kidney work? CCSD code M1000 covers therapeutic endoscopic operations on the kidney other than stone work.

Want to reduce claim errors across your practice? Pabau claims management provides electronic claim submission and invoice tracking for UK private practices.

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