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A partial or complete esophagogastric fundoplasty is a surgical procedure aimed at addressing a sliding hiatal hernia, which occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This procedure can be performed using an abdominal approach, referred to as laparotomy, or a transthoracic approach. In the laparotomy method, the surgeon may utilize a complete (360-degree) wrap, known as a Nissen fundoplication, or a partial (270-degree) wrap, referred to as a Toupet fundoplication. The complete fundoplasty involves fully encircling the esophagus with the upper part of the stomach (the fundus), while the partial fundoplasty entails a looser wrap that only partially encircles the esophagus. The surgical process begins with a midline incision in the abdomen, allowing access to the esophageal hiatus, where the hernia is located. The procedure requires careful dissection and mobilization of the stomach to facilitate the wrapping and suturing of the fundus around the esophagus, ultimately repairing the hernia and preventing future complications. This intervention is critical for alleviating symptoms associated with the hernia, such as gastroesophageal reflux, and improving the patient's quality of life.
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The esophagogastric fundoplasty procedure is indicated for the treatment of a sliding hiatal hernia, which can lead to various gastrointestinal symptoms and complications. The following conditions may warrant this surgical intervention:
The esophagogastric fundoplasty procedure involves several critical steps to ensure effective treatment of the sliding hiatal hernia. The following outlines the procedural steps:
After the esophagogastric fundoplasty, patients typically require monitoring for any complications related to the surgery. Post-procedure care may include pain management, dietary modifications, and gradual reintroduction of normal activities. Patients are often advised to follow a specific diet to minimize discomfort and promote healing. Follow-up appointments are essential to assess recovery and ensure that the surgical intervention has effectively resolved the symptoms associated with the hiatal hernia. Additionally, patients should be educated on signs of potential complications, such as difficulty swallowing or persistent reflux symptoms, which may require further evaluation.
| Short Descr | ESOPH FUNDOPLASTY LAP | Medium Descr | ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY | Long Descr | Esophagogastric fundoplasty partial or complete; laparotomy | 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 | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 43338 | Addon Code MPFS Status: Active Code APC C Esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) |
| 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Added | Added |
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