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Paraesophageal hernia

Susan Answered Fri 03rd of June, 2011 15:18:59 PM

How would you bill the following:

A midline incision was made and carried down through the subcutaneous tissue to the linea alba. The linea alba was opened from the xiphoid to the umbilicus. The incision was carried through the peritoneum and the abdomen was explored with findings as noted above. A Balfour retractor was placed into the wound, and using a Richardson retractor reflected enteriorly, the stomach was reduced into the abdominal cavity. the defect in the diaphragm was then closed with interrupted sutures of 0 silk.
When the defect was completely closed, attention was turned posteriorly and there did not appear to be any significiant defect posteriorly. The medial wall of the stomach was then sutured tot he right leaf of the diaphragm with 0 silk as well. There was no remaining defect present.
Because of the possibility of a volvulus, the lateral was of the stomach was sutured to the anterior abdominal wall to prevent volvulus. The repair was carefully evaluated and the stomach appeared to be completely reduced into the abdominal cavity, and the defect was closed.
The wound was then closed using 0 Vicryl in a figure-of-eight fashion for the fascia. The skin was closed with staples. The wound was cover with 4 x 4's.
The surgeon says to bill with 39540 and 43999. Is this correct?

SuperCoder Answered Fri 03rd of June, 2011 17:44:17 PM

The codes are correct.
For esophageal hernia the cpt code 39540 is appropriate as mentioned. For reduction of stomach, the ICD vol.3 procedure code is 44.92. If you will check ICD vol.3 crosswalk to CPT, you will find the code 43999 with description "Stomach Surgery Procedure". So, you can code 39540 and 43999.

Vicky Answered Tue 07th of June, 2011 13:02:38 PM

Why would you not use 43325 for paraesophageal hernia?

SuperCoder Answered Tue 07th of June, 2011 13:43:07 PM

43325 is a Nissen's fundoplication kind of procedure. The wording Reduction of Stomach generally lead us to think of fundoplication, but the description above doesn't look like fundoplication as usually it should be. So, I would prefer 43999 billing with a fee value of comparative CPT as physician would prefer(may be 43325).

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