43327, 43328 show the way for fundoplasty overhaul

Just-in open codes acknowledge hiatal hernia repair also

The various ways your surgeon might perform an esophagogastric fundoplast are - open or laparoscopic, through chest or abdominal wall, with or minus hiatal hernia repair, with or minus mesh. Here are the factors you will need to take into account when you try to pick the proper code(s) from among nine new choices in CPT 2011.

Take a look at these four how-to tips for paraesophageal hiatalhernia repair and fundoplication coding for this year.

Tip 1: Know Pathophysiology

When a patient is said to have a hiatal hernia, it normally means that part of the stomach has herniated through the opening in the diaphragm [esophageal hiatus] into the chest and is normally associated with esophageal reflux disease.

The hernia repair normally involves the surgeon reducing the stomach back into the abdomen and suturing the enlarged diaphragmatic hiatus. During the fundoplication procedure, say for instance Nissen, the surgeon wraps part of the fundus (top) of the stomach around the esophagus and sutured in place. This creates a 'valve' that allows food to go to the stomach from the esophagus, however prevents reflux back to the esophagus.

Tip 2: For open hiatal hernia repair with/without fundoplication, use 43332-43337

CPT 2011 brings these codes for hiatal hernia repair that'll provide you with more coding options based on the specifics of your surgeon's work:

43332 , 43333, 43334 , 43335 , 43336, 43337

You will be able to describe more properly the procedure carried out with these additional codes for paraesophageal hiatal hernias that define approach, as well as the use of mesh.

First recognize the approach -- laparotomy, thoracotomy, or thracoabdominal incision to zero in on the proper code pair.

Then choose the proper code based on whether your surgeon documents the implantation of mesh or other prosthesis.

Previous way: Placed in the CPT esophagus section, codes 43332- 43337 replace deleted codes from the diaphragm section: 39502, 39520, 39530, and 39531.

New way: When your surgeon carried out a fundoplication with hiatal hernia repair before January 1, you had to use now-deleted fundoplication code (43324) but couldn't additionally capture the hernia repair with 39502 or 39520-39531. Currently, codes 43332-43337 account for both the fundoplasty and hernia repair -- and the pay shows it.

Tip 3: Open 'Fundoplication Only' earns 43327-43328

If the surgeon carries out an open fundoplasty procedure without the hernia repair, you should choose one of the following CPT 2011 codes:

43327 -- Esophagogastric fundoplasty partial or complete; laparotomy
43328 -- thoracotomy.

As with just-in codes 43332-43337, you can distinguish the codes based on the surgical approach.

Previous way: CPT 2011 deletes code 43324 and a new text note directs you to 43327-43328. The just-in codes pay $825.97 and $1213.30, respectively.

Tip 4: For open esophageal lengthening, add +43338

If the surgeon carries out an open esophageal lengthening in addition to a fundoplasty procedure described by any of the just-in codes 43327-43328 or 43333-43337, additionally you should use the following new CPT 2011 code to capture the additional work:

43338 -- Esophageal lengthening procedure

Previous way: Before the addition of +43338, you would have reported an open Collis-Nissen procedure as 43326. CPT 2011 deletes 43326 and directs coders to the new fundoplasty codes plus +43338.

Whether it's a powerful code reference tool, a real-time claims auditor to help you reduce denials or step-by-step guidance from CPC certified experts, we've got you covered. Some of our unique products provide you the update information on ICD9 Codes and HCPCS codes , the ammunition you need to get instant success.