New Twist for Laparoscopic Hiatal Hernia Repair

This time CPT adds nine just-in codes for open hiatal hernia repair and esophagogastric fundoplication; however codes for comparable laparoscopic procedures stay the same – apart from one new add-on code you should be aware about.



Get the payments you deserve with this how-to laparoscopic coding review and get to know how to add +43283 (Laparoscopy, surgical, esophageal lengthening procedure [example, Collis gastroplasty or wedge gastroplasty] [List separately in addition to code for primary procedure]) to your laparoscopic coding tool box.



Hold on to 43281-43282 for lap hiatal hernia repair with/without Fundoplication



If your surgeon carries out a laparoscopic hiatal hernia repair, you should select the proper code based on whether the surgeon implants mesh as part of the procedure, as follows:

43281 -- Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; minus implantation of mesh

43282 -- … with implantation of mesh.



You'll see more pay for the procedure with mesh placement: $1,575.15 for 43281 versus $1,769.83 for 43282 (based on Medicare physician fee schedule national facility amount using conversion factor 33.9764).



Reason: Placing mesh takes more time and increases the risk of infection.



Laparoscopic Nissen fundoplasty is more common than open as it carries a faster recovery time and costs less to perform.



Lap ‘fundoplication only' still takes 43280



If your surgeon carries out a laparoscopic fundoplication without hiatal hernia repair, you should code the service as 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [example, Nissen, Toupet procedures).



Add +43283 for lap esophageal lengthening



If a patient has a shortened esophagus that preludes reducing a hiatal hernia, the surgeon may need to carry out a gastroplasty to successfully lengthen the esophagus.



CPT 2011 provides a new add-on code to capture the additional gastroplasty service +43283. A just-in text note instructs you to use the code in conjunction with 43280, 43281, or 43282.



For instance, if the surgeon carries out a laparoscopic paraesophageal hernia repair with fundoplication and Collis gastroplasty minus mesh placement, report 43281 and +43283.



For instance: if the surgeon carries out a laparoscopic paraesophageal hernia repair with fundoplication and Collis gastroplasty without mesh placement, use 43281 and +43283.



Previous way: Before January 1, you would have reported this laparoscopic Collis-Nissen surgery using unlisted code: 43289 (Unlisted laparoscopy procedure, esophagus).



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