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A paraesophageal hiatal hernia is a condition where the top part of the stomach, known as the fundus, protrudes into the chest cavity alongside the esophagus while the gastroesophageal junction remains in its normal position. This type of hernia can lead to various complications, including obstruction or strangulation of the stomach. The surgical procedure coded as CPT® 43333 involves a repair of this hernia through a laparotomy, which is a surgical incision into the abdominal cavity. During the procedure, a midline incision is made to access the abdominal organs. The liver is carefully retracted to expose the esophageal hiatus, allowing the surgeon to reduce the herniated stomach back into the abdominal cavity using atraumatic graspers. The procedure also involves the dissection of surrounding structures, including the gastrohepatic ligament and the phrenoesophageal membrane, to adequately access and repair the diaphragm. The hernia sac is mobilized and excised, ensuring that the anterior vagus nerve is protected throughout the process. The diaphragm is then repaired, which may involve suturing or reinforcement with mesh or other prosthetic materials, as indicated by the specific coding. Additionally, a fundoplication may be performed to prevent future reflux, with variations such as the Nissen and Toupet fundoplications providing different methods of wrapping the stomach around the esophagus. This comprehensive approach aims to restore normal anatomy and function while minimizing the risk of recurrence of the hernia.
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The procedure coded as CPT® 43333 is indicated for patients diagnosed with a paraesophageal hiatal hernia. This condition may present with various symptoms or complications, which can include:
The surgical procedure for repairing a paraesophageal hiatal hernia via laparotomy involves several critical steps, which are detailed as follows:
After the completion of the procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper recovery of gastrointestinal function. Patients may be advised on dietary modifications and activity restrictions during the initial recovery phase. Follow-up appointments are essential to assess the surgical site and ensure that the hernia repair is healing appropriately. Any concerns regarding symptoms such as persistent pain, difficulty swallowing, or signs of reflux should be addressed promptly with the healthcare provider.
| Short Descr | TRANSAB ESOPH HIAT HERN RPR | Medium Descr | LAPT RPR PARAESOPH HIATAL HERNIA W/MESH | Long Descr | Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis | 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 | 86 - Other hernia repair |
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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | GW | Service not related to the hospice patient's terminal condition | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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