Policy No: 104 Show The policy applies to physicians, other qualified health care professionals and facilities. DefinitionsBariatric Surgery Esophagogastric Fundoplasty Gastropexy Hiatal Hernia Type I Type II Type III Type IV Hiatal hernias are very common, and most are asymptomatic and require no treatment. Symptomatic hiatal hernias are generally related to gastroesophageal reflux disease (GERD) or true paraesophageal types of hiatal hernia. Policy StatementCoding CPT codes 43280 (laparoscopic), 43325, 43327, 43328 (open) are the correct codes to report for an esophagogastric fundoplasty. Per CPT and NCCI, the esophagogastric fundoplasty includes any associated type I hiatal hernia repair; which is not reported separately. CPT codes 43281, 43282 (laparoscopic), 43332, 43333, 43334, 43335, 43336, 43337 (open) can only be reported for a paraesophageal hiatal hernia repair. A paraesophageal hiatal hernia of type II, III, or IV must be clearly documented. The esophagogastric fundoplasty, if also performed, is an included component. It is not acceptable to use the paraesophageal hernia repair codes to report a type I hiatal hernia repair procedure. Edits ReferencesNone Cross ReferencesAssociated Claims What is the difference between CPT 43280 and 43281?CPT 43281 is separately payable when performed with a bariatric procedure, CPT 43280 is not. The difference between the two codes is that in 43281 the hernia sac is removed and then the area is repaired; in 43280 the hernia is only repaired via sutures.
What is laparoscopic hiatal hernia repair with Nissen fundoplication?Nissen fundoplication is a surgical procedure used to treat gastroesophageal reflux disease, or GERD, and hiatal hernia. It tightens and reinforces the sphincter at the top of the stomach to prevent stomach acid from rising into the esophagus.
What is the CPT code for laparoscopic hiatal hernia repair?CPT codes 43280 (laparoscopic), 43325, 43327, 43328 (open) are the correct codes to report for an esophagogastric fundoplasty. Per CPT and NCCI, the esophagogastric fundoplasty includes any associated type I hiatal hernia repair; which is not reported separately.
What is the CPT code 43281?The Current Procedural Terminology (CPT®) code 43281 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Procedures on the Esophagus.
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