CCSD code M3202 – Ureteric orifice operations

Key takeaways

CCSD code M3202 covers operations on the ureteric orifice, including endoscopic approaches, and sits in Chapter 12 under the ureter.

Endoscopic incision or puncture of a ureterocele is M3202, while open or laparoscopic excision is M2510 or M2511.

The CCSD lists M2730, M2920 and M3000 as unacceptable combinations with M3202 in the same episode.

The CCSD sets the complexity band (INT for M3202), and each insurer sets its own fee against it.

Pabau tracks prior authorisation codes on the case and warns staff when one is missing before a Healthcode claim goes out.

CCSD code M3202 covers operations on the ureteric orifice

CCSD code M3202 is the procedure code for operations on the ureteric orifice, including endoscopic approaches. Its official descriptor reads “Operations on ureteric orifice (including endoscopic)”. It sits in Chapter 12 of the CCSD schedule, under the ureter, and carries an intermediate (INT) complexity band.

The case you’ll code most often is a ureterocele treated through the scope. Endoscopic incision or puncture of a ureterocele is M3202. Open or laparoscopic excision belongs to M2510 for one side, or M2511 when both sides are excised. Endoscopic incision of the urethral sphincter is not an orifice operation. It has its own code, M4400.

CCSD codes are used only for UK private medical insurance billing, while the NHS codes procedures with OPCS-4. Claims for patients insured with Bupa, AXA Health, Aviva, Vitality, Healix or WPA go to the insurer with the CCSD code, usually through Healthcode. Our full CCSD code list covers the rest of the schedule.

The approach decides the code

Two things settle most M3202 coding questions: how the surgeon reached the ureterocele, and what else happened in the same episode. The diagram below maps both.

• Included: Operations on the ureteric orifice, including endoscopic incision or puncture of a ureterocele.
• Coded elsewhere: Open or laparoscopic excision of a ureterocele, which is M2510 (one side) or M2511 (both sides).
• Not billed together: The CCSD lists M2730, M2920 and M3000 as unacceptable combinations with M3202 in the same episode.

The CCSD describes its coding principles as non-exhaustive guidance. Each insurer decides whether to adopt them, so check a combination with the payer when the schedule doesn’t cover it.

A worked example: One cystoscopy, one code

Here’s an illustrative case. A consultant urologist sees an adult patient with a left-sided ureterocele causing obstruction. Under general anaesthetic, they pass a cystoscope and make a small incision in the ureterocele to drain it. The operative note records “transurethral endoscopic incision of left ureterocele”.

That note maps to M3202. M2510 would be wrong, because the ureterocele was incised through the scope rather than excised. If another ureteric procedure happened in the same session, check its code against the CCSD combination list first. M2730, M2920 and M3000 can’t sit on the same claim as M3202.

What the paperwork behind an M3202 claim needs

Insurers review the claim against the record, so the documentation has to prove the approach. A complete M3202 file usually holds:

• Operative note: The procedure, the side, the indication and the approach. “Endoscopic incision” and “excision” lead to different codes, so the wording matters.
• Referral letter: A GP or specialist letter confirming the clinical need. Some insurers check that the treating consultant is named in it.
• Consultant details: The consultant’s GMC number and their recognition number with the insurer.
• Pre-authorisation reference: The number the insurer issued before the procedure.
• ICD-10 diagnosis code: The diagnosis that supports medical necessity, such as the ureterocele itself. Confirm what each insurer expects.

Pre-authorisation: Ask before the list is booked

Most insurers want pre-authorisation for elective surgery, but the rules vary by insurer and by policy. Confirm the requirement for M3202 before the patient is booked, not after. Our Bupa CCSD codes guide covers Bupa’s process in more detail.

Turnaround times vary by insurer and by case, so see the payer’s provider portal rather than relying on a fixed number.

How the claim moves through Healthcode

Healthcode is the main electronic route for CCSD-coded claims in the UK. It checks a claim’s fields before the insurer sees it, which catches simple errors early.

1. Open a new claim for the patient’s episode.
2. Enter M3202 in the procedure code field. Confirm the descriptor shown matches the procedure performed.
3. Add the pre-authorisation number. A missing or invalid number is a common validation failure.
4. Add the consultant’s GMC number and their recognition number with this insurer.
5. Add the ICD-10 diagnosis code that supports the procedure.
6. Enter the fee from the insurer’s current schedule.
7. Run the validation check and fix anything it flags.
8. Submit and keep the reference number for any follow-up query.

Before you submit: A five-point check

Run through this list before every M3202 claim leaves the practice. It takes a couple of minutes.

• The operative note names the approach, and it’s endoscopic incision or puncture rather than excision.
• No M2730, M2920 or M3000 sits on the same claim.
• The pre-authorisation number is on the claim and still valid.
• The consultant’s GMC and insurer recognition numbers are correct.
• The fee comes from the insurer’s current schedule.

Why M3202 claims come back

Rejections on this code tend to fall into a handful of patterns. Each one has a fix, and most can be prevented before submission.

Fees: The CCSD sets the band, insurers set the price

The CCSD doesn’t publish a fee for M3202. It assigns the code a complexity band, which is INT for this code. Each insurer then sets its own fee against that band, and the rate can differ by contract.

Always bill from the most recent version of the insurer’s schedule. Insurers can update their schedules during the year. A claim at a superseded rate is likely to be queried, even when the coding is right.

How Pabau keeps M3202 claims complete before they go

On a manual workflow, the pre-authorisation number lives in an email and the claim is typed into Healthcode by hand. A missing reference only shows up when the claim fails validation.

Pabau, the practice management platform we build, submits CCSD-coded claims to Healthcode straight from the patient record. Its claims management software also handles Bupa claim submission. Prior authorisation codes, dates and approved sessions are tracked on the case, and staff get a warning when one is missing.

The claim reaches Healthcode with its authorisation in place, and your team can follow its status without chasing paper. Code choice stays with your coders, who match the operative note to M3202 or M2510.

Send complete CCSD claims through Healthcode

Pabau submits CCSD-coded claims to Healthcode from the patient record. It tracks prior authorisation codes on each case and warns staff when one is missing.

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Conclusion

M3202 is a narrow code, and the operative note decides most claims. If the note says the ureterocele was incised through the scope, M3202 is the code. If it says excised, it isn’t.

Get surgeons to name the approach, keep the three unacceptable combinations off the claim, and confirm pre-authorisation before the list is booked. Do those three, and the remaining rejections are mostly fee and recognition details you can fix in a day.

Book a demo to see how Pabau keeps the authorisation on each M3202 claim before it reaches Healthcode.

Continue your research

Billing a Bupa patient? Bupa CCSD codes covers Bupa’s procedure schedule, pre-authorisation and fee lookups.

Was the ureterocele excised instead? CCSD code M2510 explains the open or laparoscopic excision code.

Removing a ureteric stent later? CCSD code M2930 covers removal of a prosthesis from the ureter.

Treating ureteric stones with ESWL? CCSD code M3110 walks through ureteric ESWL billing and pre-authorisation.

Want fewer rejected insurance claims? Pabau claims management software sends Healthcode claims from the patient record and tracks authorisations on each case.

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