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A paraesophageal hiatal hernia is a condition where the upper 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 repair of a paraesophageal hiatal hernia, specifically through a thoracoabdominal incision, is a surgical procedure that addresses this condition effectively. This approach is particularly indicated for patients who have undergone previous surgeries for diaphragmatic hernias or those with hernias that cannot be reduced manually. The procedure involves a combination of thoracic and abdominal incisions to provide adequate access to the affected areas. During the surgery, the herniated stomach is repositioned back into the abdominal cavity, and if necessary, a fundoplication may be performed to prevent future reflux. This procedure is performed without the use of mesh or other prosthetic materials, distinguishing it from similar procedures that may involve such implants. The careful dissection and repair of the diaphragm and esophagus are critical components of this surgical intervention, ensuring both the immediate correction of the hernia and the long-term stability of the anatomical structures involved.
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The repair of a paraesophageal hiatal hernia via thoracoabdominal incision is indicated for the following conditions:
The procedure for repairing a paraesophageal hiatal hernia involves several critical steps:
Post-procedure care for patients undergoing repair of a paraesophageal hiatal hernia typically includes monitoring for complications such as infection, bleeding, or respiratory issues due to the thoracic approach. Patients may require pain management and will be advised on activity restrictions during the recovery period. Follow-up appointments are essential to assess healing and ensure that the hernia repair is successful. Additionally, patients may be educated on dietary modifications to prevent complications related to reflux or other gastrointestinal issues following the surgery.
| Short Descr | THORABD DIAPHR HERN REPAIR | Medium Descr | RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH | Long Descr | Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without 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. | 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.) | 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 |
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| 2011-01-01 | Added | Added |
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