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Paraesphageal Hernia Repair CPT 43281

Camille Posted Tue 25th of February, 2020 18:41:38 PM
In my Coder's Desk Reference for Procedures, part of the description for a laparoscopic paraesophageal hernia states that the physician reduces the herniated stomach into the abdomen and dissects the hernia sac and gastroesophageal fat pad. Question: If the hernia sac was reduced but not dissected, is CPT 43281 still correct to code? Thank you!
SuperCoder Answered Wed 26th of February, 2020 08:57:23 AM

Hi Camille,

Thank you for your question,

If the hernia sac was reduced laparoscopically but not dissected, we will still bill CPT 43281 with modifier 52. However, When manual reduction is the only service performed, unlisted code 49999 may be reported. Fell free to ask for any further query. 

Camille Posted Wed 26th of February, 2020 12:54:54 PM
Thank you! QUESTION: Is there any specific verbiage in this Op Note excerpt that you would interpret to mean the hernia sac was dissected? I capitalized the sentence I'm unsure of. First, provider performed a Laparoscopic Gastric Sleeve. "I oversewed the upper 3 cm of the staple line with a figure-of-eight 3-0 Vicryl suture. I had noticed that the staple line then protruded above the diaphragm which was concerning for a hiatus hernia. I then took down the phrenoesophageal attachments circumferentially. He had a moderate-sized hiatus hernia. The hernia sac was reduced. I DID AN EXTENSIVE MEDIASTINAL DISSECTION. The anterior and posterior vagal nerves were preserved. I did a posterior cruroplasty by in placing a figure-of-eight 0 Ethibond in the right and left crura. The staple line remained in the abdomen under no tension. This closed the hernia defect nicely. Hemostasis was secured along the staple line. Ethicon SNoW was applied along the length of the staple line. I did an omentopexy by sewing the omentum to the posterior antrum using a 3-0 Vicryl."
SuperCoder Answered Thu 27th of February, 2020 08:40:57 AM

Hi Camille,

 

It is important to note that there are two methods to repair paraesophageal hernia;

  • one is without dissecting hernia sac.
  • other is with dissection of hernia sac.

In the above procedure there is nowhere mentioned that hernia sac was dissected. However, it is clearly mentioned there was moderate-sized hiatus hernia which was repaired by reducing through mediastinal dissection and then repaired with posterior cruroplasty by placing a figure-of-eight 0 Ethibond in the right and left crura. So, it is correct to bill CPT 43281. Also, see the link below to give more clarity on procedure.   Thank you.

 

https://www.ncbi.nlm.nih.gov/pubmed/10522848

 

NOTE:

Minor and small sized hiatus hernia can be treated without dissecting the sac.

Large hiatal hernias can be treated effectively laparoscopically. Dissecting the sac fully from the mediastinum before dissecting the esophagus helps to safely mobilize the esophagus, and we think changing to this strategy is the main reason for the improved laparoscopic success rate reported in the latter half of this series.

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