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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 different approaches, specifically an abdominal approach or a transthoracic approach. In the abdominal approach, as described in CPT® Code 43327, the surgeon utilizes 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 fundus (the upper part of the stomach), while the partial fundoplasty entails a looser wrap that only partially encircles the esophagus. In contrast, CPT® Code 43328 describes the transthoracic approach, which may utilize techniques such as the Belsey IV or Belsey Mark IV (BMIV). This method involves making an incision in the chest above the diaphragm, allowing the stomach to be mobilized and pulled into the thoracic cavity. The fundus is then partially wrapped around the esophagus and secured to the esophageal muscle layer. Additionally, the Hill procedure is another technique that may be employed, which focuses on anchoring the stomach to the diaphragm to prevent future herniation and involves suturing the diaphragm's crura to narrow the hiatus. Overall, these procedures are critical for alleviating symptoms associated with hiatal hernias and restoring normal anatomical function.
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The esophagogastric fundoplasty, whether performed partially or completely, is indicated for the treatment of a sliding hiatal hernia. This condition is characterized by the displacement of the stomach into the thoracic cavity through the diaphragm, which can lead to various gastrointestinal symptoms and complications.
The procedure for esophagogastric fundoplasty involves several critical steps, which may vary slightly depending on whether the abdominal or transthoracic approach is utilized.
Post-procedure care for patients undergoing esophagogastric fundoplasty typically involves monitoring for complications such as infection, bleeding, or recurrence of the hernia. Patients may be advised to follow a specific diet and gradually reintroduce solid foods as tolerated. Pain management and follow-up appointments are essential to ensure proper healing and assess the success of the procedure. Additionally, patients may receive instructions on activity restrictions to promote recovery and prevent strain on the surgical site.
| Short Descr | ESOPH FUNDOPLASTY THOR | Medium Descr | ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY | Long Descr | Esophagogastric fundoplasty partial or complete; thoracotomy | 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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 |
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| 2011-01-01 | Added | Added |
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