CCSD code M3110 – Extracorporeal shockwave lithotripsy of calculus of ureter

Key takeaways

CCSD Code M3110 covers extracorporeal shockwave lithotripsy of a stone in the ureter. A kidney stone treated the same way takes M1400.

N20.1 (calculus of ureter) is the usual ICD-10 pairing for M3110, and N20.2 applies when kidney and ureter stones occur together.

Imaging guidance, stent insertion and anaesthesia are coded separately, because M3110 covers the shockwave session only.

Most UK private medical insurers require pre-authorisation before ureteric ESWL, and a missing authorisation reference is a common denial trigger.

Pabau’s claims management software stores each pre-authorisation as a case and sends claims to Bupa, AXA Health and Vitality through Healthcode.

CCSD Code M3110: Definition, scope and clinical context

CCSD Code M3110 is the Clinical Coding and Schedule Development code for extracorporeal shockwave lithotripsy (ESWL) of a calculus of the ureter. High-energy shockwaves are focused on a ureteral stone from outside the body. The stone breaks into fragments that pass naturally through the urinary tract.

The CCSD schedule organises urology codes by anatomical site. M3110 sits in the ureter section of chapter 12 and covers the whole ureter, from the ureteropelvic junction to the ureterovesical junction. Our CCSD codes index lists the neighbouring urology procedures in the same schedule.

The code covers one treatment session. Repeat sessions for the same stone episode are billed separately and, in most cases, need fresh pre-authorisation.

How ESWL of a ureteral calculus works

ESWL for a ureteral stone is a non-surgical outpatient procedure. Knowing the clinical steps helps billing staff match the operative note to M3110 and spot ancillary services that take their own code.

1. Patient positioning and imaging: The patient lies on a treatment table, and fluoroscopy or ultrasound localises the ureteral stone. This imaging guidance is a separate billable service.
2. Coupling and targeting: A water-filled cushion or water bath couples the shockwave source to the skin. The lithotripter is set to focus shockwaves on the stone’s coordinates.
3. Shockwave delivery: Between 1,500 and 3,000 shockwaves are delivered per session, depending on stone size, density and patient tolerance. The urologist raises power in steps.
4. Monitoring during treatment: Periodic fluoroscopy checks confirm fragmentation and track stone movement. Each imaging check belongs to the guidance service, not to M3110 itself.
5. Post-procedure assessment: Imaging confirms the result at the end of the session. The operative note records the ureter segment, shockwave count, energy settings, imaging modality and outcome.

The procedure typically takes 45 to 60 minutes. A ureteral stent inserted beforehand to help fragments pass is a separate procedure with its own CCSD code. Taking that stent out later by cystoscopy is a separate claim again, billed as CCSD M2930. Anaesthesia, whether general or intravenous sedation, is coded separately too.

What M3110 covers and what it excludes

M3110 covers the shockwave lithotripsy session applied to the ureteral stone only. It does not bundle imaging guidance, stent procedures or anaesthesia. Coding each one correctly prevents both underclaiming and insurer rejections for over-coding.

M3110 vs neighbouring CCSD codes

The stone’s location decides which lithotripsy code applies. M3110 versus M1400 is the most common mix-up in private urology billing, because both codes describe shockwave treatment from outside the body.

The line between M1400 and M3110 is anatomical. The operative note must state whether the stone sat in the kidney or the ureter at the time of treatment. Where ureteroscopy only examines the ureter and removes no stone, M3000 applies instead. A kidney stone broken up through a flexible ureteroscope rather than by shockwaves takes CCSD code M0910.

A stone can migrate from the kidney to the ureter between pre-operative imaging and the procedure date. The operative note should then record the intraoperative confirmation.

Coders who work from the referral letter instead of the operative note risk choosing the wrong code. The chart below sets out the three codes by stone site and approach.

Correct ICD-10 diagnosis codes to pair with M3110

Every CCSD Code M3110 claim needs a supporting ICD-10 diagnosis code on the claim form. The ICD-10 code confirms clinical necessity and must match the stone location documented in the medical record. Check the selection against the clinical notes, instead of defaulting to one code for every ureteral stone.

N20.1 is the most specific diagnosis code for the large majority of M3110 claims. Using N23 when the stone site is documented invites insurer queries and requests for further clinical justification. The Bupa code search tool lets billing teams check accepted diagnosis pairings for each procedure code before submission.

Ancillary and add-on codes commonly billed with CCSD Code M3110

Several legitimate ancillary codes often accompany M3110 claims. Each one is a separate service and needs its own documentation. Billing them without confirming that each service was delivered and recorded is an unbundling risk.

Pre-authorisation requirements for UK private insurers

UK private medical insurers treat ureteric ESWL as an elective urology procedure that needs pre-authorisation. A claim for M3110 without an authorisation reference is one of the quickest routes to a denial in private urology billing. Requirements vary by insurer, so check the current benefit schedule at the time of service.

• Referral letter: A GP or specialist referral confirming the diagnosis (ureteral calculus) and the clinical case for ESWL over ureteroscopy.
• Imaging evidence: CT KUB or plain KUB X-ray confirming stone location, size and density. Most insurers expect imaging dated within a set period before the procedure.
• Clinical justification: Documentation that conservative management (hydration, analgesia, watchful waiting) has been considered. It should also show that ESWL suits the stone’s size and position.
• Authorisation reference number: Obtained from the insurer before the procedure date. This number must appear on every claim line for the episode.
• Insurer-specific forms: Bupa, AXA Health, Vitality Health and Aviva each run their own pre-authorisation portals and forms. Using the wrong form or channel causes delays.

Vitality and Aviva each publish provider fee schedules, so billing teams can check procedure-specific requirements and reimbursement levels.

Approval timelines differ between insurers, so submit pre-auth requests well before the procedure date. For Bupa claims, our Bupa CCSD codes guide covers how the schedule works and what submission needs.

Documentation requirements for a clean M3110 claim

A clean M3110 claim stands on the operative or procedure note. Every element listed below should be present before the claim is submitted. Missing documentation is both a denial risk and an audit exposure.

1. Anatomical confirmation: The note must state explicitly that the stone was in the ureter, naming the segment (proximal, mid, distal or ureterovesical junction) where possible.
2. Imaging modality used: Record whether fluoroscopy or ultrasound was used for localisation and monitoring, and who performed it.
3. Shockwave parameters: Document the total number of shockwaves delivered and the peak energy setting. Insurers increasingly request this data to assess clinical reasonableness.
4. Outcome at session end: Note whether fragmentation was achieved, whether the stone passed, and whether any complications occurred.
5. Stent status: If a JJ stent was inserted or was already in situ, record it clearly. Note whether it was placed before, during or after the ESWL session.
6. Anaesthesia type: Record general anaesthesia, IV sedation or no anaesthesia. This supports the anaesthetist’s separate claim and prevents disputes.

Pabau, the practice management platform we build, lets urology teams set up structured procedure note templates. Setting these six elements as required fields means each note reaches billing with every element filled in.

Common claim denial reasons and how to avoid them

ESWL claims for ureteral stones are denied for a small set of predictable reasons. Most are avoidable with the right pre-submission checks.

Billing multiple ESWL sessions for the same ureteral stone

Not every ureteral stone fragments fully in a single session. When a stone persists, a second or third ESWL session may be clinically justified. Each session is billed under M3110, and each one needs its own pre-authorisation and clear record of clinical necessity.

• Fresh pre-authorisation: Most private medical insurers treat each session as a separate authorisation event. The authorisation for session one does not automatically cover session two.
• Interval and imaging evidence: Insurers generally expect follow-up imaging between sessions, such as plain KUB, CT KUB or ultrasound. It confirms the residual stone burden and justifies another attempt before ureteroscopy.
• Clinical necessity documentation: The request should reference the first session’s outcome and the residual fragment’s size and density. It should also explain why ESWL is repeated instead of moving to ureteroscopy (M2730).
• Session caps: Some insurer benefit schedules limit the number of ESWL sessions reimbursable for a single stone episode. Check the current benefit schedule, as these limits change periodically.
• Appeal pathway: If a second session is denied, a supporting letter from the consultant urologist is usually the strongest appeal evidence. It should explain why ureteroscopy is not preferred at this stage.

How Pabau supports M3110 pre-authorisation and claims

Many urology billing teams track M3110 episodes across an insurer portal, a spreadsheet of authorisation numbers and the clinical record. A reference typed into the wrong place, or missing from a repeat session, comes back weeks later as a denial.

Pabau’s claims management software stores each insurer pre-authorisation as a case. Staff attach the case when booking the ESWL session, so the authorisation reference follows the appointment onto the claim.

Claims go to Bupa, AXA Health, Vitality, WPA and Aviva through Healthcode, and Bupa cover can be checked in seconds before the session. Claim validation flags missing or invalid details before submission. The dashboard then tracks every claim from Pending to Paid, searchable by authorisation code.

Keep every M3110 claim authorised and complete

Pabau stores each pre-authorisation as a case, validates claims before submission and sends them to UK insurers through Healthcode. See how it fits a private urology practice.

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Conclusion

M3110 rarely fails on the code itself. Claims fail when the record cannot show where the stone sat, how it was treated, and that the insurer authorised that session.

Make the operative note the source of the code, and treat every repeat session as a new authorisation. A practice that does both turns ureteric ESWL into one of the more predictable claims in private urology.

Book a demo to see how Pabau links each ESWL session to its pre-authorisation and sends the claim through Healthcode.

Continue your research

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