CCSD code M1910 – Ileal conduit construction with ureteric implantation

Key takeaways

CCSD Code M1910 covers construction of an ileal conduit with ureteric implantation, not continent diversions such as a neobladder.

Bowel segment isolation, re-anastomosis and stoma formation are part of the procedure. Ureteric stenting and pre-operative stoma siting may need separate coding.

On Bupa’s schedule, total cystectomy codes such as M3400 already include the conduit, so M1910 is billed only when the conduit is the main procedure.

Operative notes must confirm bilateral ureteric implantation, ileal segment length, stoma site and restored bowel continuity to satisfy insurer requirements.

Pabau’s claims management software stores each pre-authorisation and validates claims before they reach Healthcode.

CCSD Code M1910: Definition and clinical description

CCSD Code M1910 is defined by the Clinical Coding and Schedule Development (CCSD) schedule with the official descriptor: Construction of ileal conduit including ureteric implantation.

It covers the complete surgical creation of an incontinent urinary diversion from a segment of ileum. Both ureters are joined directly to that segment, and its distal end is brought to the abdominal wall as a urostomy stoma.

M1910 sits in chapter 12 of the CCSD schedule, urinary system and male reproductive organs, in the ureter section. The operating consultant urologist bills it for the primary surgical episode.

Anaesthetist fees are billed separately using the applicable CCSD anaesthesia schedule. Histopathology, post-operative stoma nurse follow-up and stoma appliance supplies fall outside this code entirely.

What the procedure involves: Construction of an ileal conduit

The ileal conduit is also known as the Bricker conduit or ileal loop urinary diversion. It involves four surgical steps that coders and billing teams should recognise in an operative note.

1. Ileal segment isolation: A 15-20 cm segment of distal ileum is mobilised and divided, preserving its mesenteric blood supply. Small bowel continuity is restored by end-to-end anastomosis of the remaining ileal ends.
2. Ureteroileal anastomosis: Both ureters are spatulated and anastomosed into the isolated ileal segment, most commonly using the Wallace or Bricker technique. This is the ureteric implantation component named in the M1910 descriptor.
3. Stoma formation: The distal end of the ileal segment is brought out through the right iliac fossa and everted to form a urostomy stoma. Urine then drains continuously into an external appliance.
4. Bowel re-continuity: The divided ileal ends are anastomosed to restore small bowel function. Under current CCSD guidance this step is integral to the procedure, not a separately billable intervention.

The operative note should reflect all four components. A report that describes only the stoma formation, without documenting bilateral ureteric implantation, is a common trigger for a claim query from UK private insurers.

Primary indications for ileal conduit surgery

Clinically, most ileal conduits are built as the urinary diversion after radical cystectomy for muscle-invasive bladder cancer (MIBC).

British Association of Urological Surgeons (BAUS) guidance treats the ileal conduit as the standard incontinent diversion. It suits patients who are not suitable for, or do not choose, a continent reconstruction.

When the conduit is built during a total cystectomy, Bupa bills the whole operation under the cystectomy code, as the next sections explain. M1910 is billed when the conduit is the main procedure, for indications such as these:

• Neurogenic bladder with intractable incontinence or recurrent upper tract infection resistant to conservative measures
• Bladder fistulae (vesico-vaginal or vesico-enteric) unresponsive to repair
• Pelvic exenteration for locally advanced pelvic malignancy requiring bladder sacrifice
• Severe radiation cystitis following pelvic radiotherapy with irreversible bladder damage
• Complex bladder trauma where primary repair is not feasible

The billing team should confirm the primary diagnosis in the clerk-in notes and the oncology MDT letter. The indication directly informs the insurer’s medical necessity assessment.

What CCSD Code M1910 includes and excludes

Knowing the bundling boundaries of CCSD Code M1910 prevents under-coding. It also prevents duplicate-billing denials, which arise when integral sub-procedures are submitted as separate line items.

The bundling status of intraoperative JJ stents is the most common grey area. Some insurers treat stents placed to support the ureteroileal anastomosis as integral, while others accept a separate stenting code. Check the current CCSD schedule edition and the insurer’s unbundling policy before submitting a stenting line item alongside M1910.

Adjacent and related CCSD codes

Correct code selection depends on knowing which CCSD codes sit closest to M1910 and when each applies. The table below covers the codes most often confused with M1910 in urology billing, with descriptors from the Bupa schedule.

Always cross-reference against the current CCSD schedule before submitting. Code descriptors and bundling rules are subject to annual revision and individual insurer schedule amendments.

The quickest way to choose between these codes is to follow where the ureters end up in the operative note, as the chart below shows.

Our CCSD code library covers the neighbouring ureter codes in more depth. If the surgeon reimplants both ureters into the bladder instead, the page on M2030 sets out its documentation.

Ileal conduit vs neobladder: Choosing the correct CCSD code

The clinical distinction between an ileal conduit and a neobladder maps directly onto different CCSD codes. Getting this wrong is the most common miscoding error in urinary diversion billing.

The operative report is the definitive guide to code selection. If it describes a continent reservoir anastomosed to the urethra, M1910 does not apply. Insurers will spot a continent diversion billed under M1910 on clinical review.

M1910 and cystectomy: When the conduit is already included

Every total cystectomy code on Bupa’s schedule includes the conduit. Open total cystectomy (M3400), robotic assisted cystectomy (M3410) and laparoscopic cystectomy (M3420) all read “with construction of intestinal conduit or bladder”. The cystoprostatectomy codes M3411 and M3412 carry the same wording.

Adding M1910 to one of those claims bills the conduit twice, so the insurer will query it as unbundling. Three checks keep the claim clean.

• Choose the code before preauthorisation: The request should name the exact code you will submit. A cystectomy with a conduit goes in under the cystectomy code alone.
• Check each insurer’s descriptor: Insurers publish their own CCSD-based schedules. Confirm that the cystectomy descriptor includes the conduit before you decide whether M1910 belongs on the claim.
• Keep M1910 for standalone diversions: Submit it when the conduit is the main procedure. A diversion for neurogenic bladder with the bladder left in place is one example.

Pabau, the practice management platform we build, opens each claim pre-filled from the invoice. Its claims management software then validates the claim and flags missing details before it reaches Healthcode.

Documentation requirements for a valid M1910 claim

UK private insurers assess M1910 claims against the operative note. A well-structured report removes ambiguity and the most common grounds for a query or denial.

The operative note should include each of these items:

• Procedure name: State “construction of ileal conduit including bilateral ureteric implantation” verbatim or as a close equivalent.
• Ileal segment details: Document the segment length (typically 15-20 cm), anatomical origin (distal ileum), and the mesenteric pedicle used.
• Ureteroileal anastomosis technique: Name the technique (Wallace, Bricker or other) and confirm bilateral implantation. Note whether ureteric stents were placed, and whether they were removed or left in situ.
• Stoma formation: Record the site (right iliac fossa is standard), the type of stoma (urostomy), and whether pre-operative siting was performed by a stoma nurse.
• Bowel continuity: Confirm the method of small bowel re-anastomosis and any intraoperative findings affecting this step.
• Surgeon details: Consultant urologist name, GMC number, and operating date.
• Indication: Confirm the primary diagnosis (e.g. muscle-invasive transitional cell carcinoma of bladder, pT2 or higher) with reference to the MDT decision.

A digital operative note template with a field for each item keeps the note complete. It also makes the note quick to retrieve when an insurer asks for supporting records.

Preauthorisation requirements for UK private insurers

All major UK private medical insurers require preauthorisation before elective urological surgery of this complexity. Submit the request before the procedure, because retrospective requests are routinely declined or reviewed under stricter criteria.

The preauthorisation request should name the CCSD code you will bill and any planned companion codes. Add the consultant’s name and GMC number, the clinical indication with staging information, and the planned hospital and admission date.

Insurers may take 3-10 working days to authorise complex oncological cases, so factor this into surgical booking timelines.

Common reasons CCSD M1910 claims are denied

Denials for M1910 cluster around four recurring issues. Each has a straightforward fix when caught before submission.

• Missing preauthorisation: The authorisation was not obtained, was obtained for the wrong procedure, or its reference was missing from the claim form. Fix: Build an authorisation checklist into surgical booking and attach the reference number to every claim.
• Incomplete operative note: The note lacks bilateral ureteric implantation confirmation, stoma description, or bowel continuity documentation. Insurers request the operative report and decline on clinical review. Fix: Use a structured operative note template that requires sign-off on each M1910 component before the note is finalised.
• Incorrect code selection: M1910 was submitted for a continent diversion such as a neobladder or Mitrofanoff. Or it was added to a total cystectomy code that already includes the conduit. Fix: Review code selection against the operative report, not the booking diagnosis.
• Duplicate billing with excluded sub-procedures: A separate stoma formation code or bowel anastomosis code submitted alongside M1910 when that component is integral. Fix: Check the current CCSD schedule bundling rules before adding companion codes.

Keep authorisation references, operative notes and every submitted claim version together. An appeal needs all three, and assembling them after a denial costs days.

How Pabau keeps M1910 claims clean before submission

In many urology practices, someone checks each M1910 claim by hand. They compare the authorisation letter, the operative note and the insurer’s schedule, often in three different places.

Pabau holds those pieces against one patient record. Each pre-authorisation is stored as a case and attached when the surgery is booked. The invoice is raised to the patient’s insurer at its contract rate, and the claim opens pre-filled from it.

Claim validation flags missing or invalid details before the claim goes to Healthcode, and the claims dashboard shows every claim that needs action. A missing authorisation reference gets fixed before Bupa can query it. For descriptors across the schedule, our guide to Bupa CCSD codes explains how it is structured.

Manage CCSD claims with confidence

Pabau stores each pre-authorisation, raises the claim from the invoice and validates it before it reaches Healthcode, so fewer M1910 claims come back.

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Conclusion

Before you submit M1910, settle one question. Was the conduit the main procedure, or part of a total cystectomy? On Bupa’s schedule the cystectomy code already covers the conduit, so M1910 belongs only on standalone diversions.

Once the code is right, the remaining denial risks are paperwork. An authorisation that names the code you bill, and an operative note that records all four steps, remove the usual grounds for a query.

Book a demo to see how Pabau tracks pre-authorisations and validates CCSD claims before they reach Healthcode.

Continue your research

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