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The procedure described by CPT® Code 43284 involves a laparoscopic surgical technique aimed at augmenting the esophageal sphincter. This is specifically achieved through the placement of a sphincter augmentation device, commonly referred to as a magnetic band, around the lower esophageal sphincter (LES). The primary purpose of this procedure is to treat gastroesophageal reflux disease (GERD), a condition where stomach contents flow back into the esophagus, causing symptoms such as heartburn and regurgitation. During the laparoscopic approach, the gastroesophageal junction (GEJ) is visualized, allowing the surgeon to perform the necessary dissection with minimal invasiveness. The procedure may also include cruroplasty, which is a surgical repair of the diaphragm's crura, particularly when there is a hiatal hernia present. This involves adjusting the opening in the diaphragm to prevent the stomach from protruding into the chest cavity. The magnetic band itself is designed to maintain closure of the LES while allowing it to open during swallowing, thus providing a functional solution to the reflux issue. Overall, this procedure combines advanced laparoscopic techniques with innovative device technology to enhance patient outcomes in managing GERD.
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The laparoscopic esophageal sphincter augmentation procedure (CPT® Code 43284) is indicated for patients suffering from gastroesophageal reflux disease (GERD) who have not achieved adequate symptom control through lifestyle modifications and pharmacological treatments. This procedure is particularly suitable for individuals with a documented history of reflux symptoms, such as heartburn and regurgitation, that significantly impact their quality of life. Additionally, it may be indicated for patients with a hiatal hernia that contributes to their reflux symptoms, necessitating surgical intervention to repair the hernia and augment the esophageal sphincter.
The laparoscopic esophageal sphincter augmentation procedure involves several key steps to ensure successful implantation of the sphincter augmentation device. First, the surgeon performs a standard laparoscopic approach to visualize the gastroesophageal junction (GEJ). This visualization allows for careful dissection of the area where the magnetic band will be placed. The peritoneal reflection is then divided, while preserving the mediastinal cavity and the phrenoesophageal ligament to maintain anatomical integrity. Following this, the posterior vagus nerve is identified and exposed, which is crucial for the subsequent steps. A small opening is created between the posterior vagus nerve and the esophageal body to facilitate the placement of the band. Next, the circumferential diameter of the esophagus at the GEJ is measured using a sizing instrument to select the appropriate size of the magnetic band. The band, composed of interlinked titanium beads with magnetic cores, is designed to fit snugly around the LES, providing closure while allowing for expansion during swallowing. The band is inserted through the previously created opening, encircling the esophagus at the LES, with the ends of the band secured anteriorly to ensure stability. If cruroplasty is indicated, the procedure continues with the repair of an enlarged hiatal opening in the diaphragm. This involves reducing the contents of the hernia sac and reapproximating the diaphragmatic crura with permanent interrupted sutures to restore the normal anatomy and prevent further herniation. Finally, once the device is in place and any necessary repairs are completed, the laparoscope and other instruments are removed from the abdominal cavity. The carbon dioxide used for insufflation is released, and the incisions are closed using sutures, staples, or Steri Strips, completing the procedure.
After the laparoscopic esophageal sphincter augmentation procedure, patients are typically monitored for any immediate complications and to ensure proper recovery. Post-procedure care may include pain management and instructions on dietary modifications to facilitate healing. Patients are often advised to start with a liquid diet and gradually progress to solid foods as tolerated. Follow-up appointments are essential to assess the effectiveness of the procedure and monitor for any potential complications, such as dysphagia or device-related issues. It is important for patients to adhere to their healthcare provider's recommendations regarding activity restrictions and follow-up care to ensure optimal recovery and long-term success of the procedure.
| Short Descr | LAPS ESOPHGL SPHNCTR AGMNTJ | Medium Descr | LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL | Long Descr | Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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