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 correct procedure coding for a laparoscopic sleeve gastrectomy with hiatal hernia repair and endoscopy?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.
Can I get the gastric sleeve with a hiatal hernia?At Houston Weight Loss Surgery Center, we have learned over the past few years that any size hiatal hernia must be repaired during gastric sleeve surgery to prevent post-operative GERD and bile gastritis.
What is the CPT code for laparoscopic sleeve gastrectomy?Group 1. What is the difference between CPT 43281 and 43282?Code paraesophageal hernia repairs by laparoscopic approach with 43281 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh or 43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of ...
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