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Open 'Fundoplication Only' Gets 43327-43328 There are several methods your surgeon may perform an esophagogastric fundoplasty: it could be either open or laparoscopic, through chest or through abdominal wall, could include or exclude hiatal hernia repair, with or without mesh …. Besides these are the aspects you'll need to keep in mind when you try to select the proper code(s) from among nine new choices in CPT 2011. Read on for general surgery billing and coding expert insight and learn about the guidelines for paraesophageal hiatalhernia repair as well as the fundoplication coding for 2011. Tip 1: Get Well-Versed With Pathophysiology When a patient is pronounced as having a hiatal hernia, it generally implies that part of the stomach has herniated over the opening that exists in the diaphragm [esophageal hiatus] into the chest and is generally linked with esophageal reflux disease. Remember, the hernia repair normally involves the surgeon decreasing the stomach back into the abdomen and closing the enlarged diaphragmatic hiatus. All through the fundoplication procedure, for instance Nissen, the surgeon furthermore wraps portion of the fundus (top) of the stomach round the esophagus and sutured in place. This makes a "valve" that lets food to go to the stomach from the esophagus but stops reflux back to the esophagus. Tip 2: Use 43332-43337 for Open Hiatal Hernia Repair Including/ExcludingFundoplication CPT 2011 presents the following listed codes for hiatal hernia repair that will give you added coding options established on the details of your surgeon's work: 43332 –- {Repair, paraesophageal hiatal hernia (including fundoplication), through laparotomy, excluding neonatal; minus implantation of mesh or other prosthesis} 43333 -- {by means of implantation of mesh or added prosthesis} 43334 -- {Repair, paraesophageal hiatal hernia (including fundoplication), through thoracotomy, excluding neonatal; minus implantation of mesh or other prosthesis} 43335 -- {with implantation of mesh or added prosthesis} 43336 -- {Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, excluding neonatal; without implantation of mesh or other} 43337 -- {...with implantation of mesh or other prosthesis.} You could more effectively define the procedure performed with these added codes for paraesophageal hiatal hernias that describe approach, and also the use of mesh. Tip 3: Open 'Fundoplication Only' Gets 43327-43328 In case the surgeon executes an open fundoplasty procedure minus the hernia repair, then you should choose one of the following listed CPT 2011 codes: 43327 – {Esophagogastric fundoplasty partial or complete; laparotomy} 43328 – { thoracotomy. } As per with new codes 43332-43337, you can differentiate the codes based on the surgical approach. Tip 4: Addition of +43338 for Open Esophageal Lengthening In case the surgeon carries out an open esophageal lengthening additionally to a fundoplasty procedure defined by any of the recent codes 43327-43328 or 43333-43337, you are supposed to furthermore report the following listed new CPT 2011 code to capture the extra work: +43338 – {Esophageal lengthening procedure (e.g., Collis gastroplasty or wedge gastroplasty) (List distinctly along with code for primary procedure) } Want to know get more expert general surgery billing and coding tips like these? Click here to read the entire article and to get access to our monthly General Surgery Coding Alert: Your practical adviser for ethically optimizing general surgery billing and coding, payment, and efficiency for general surgery practices. Read more to perfect your general surgery billing and coding: http://www.supercoder.com/articles/articles-alerts/gca/cpt-2011-43327-43328-lead-the-way-for-fundoplasty-overhaul/
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