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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 surgical procedure described by CPT® Code 43337 involves a repair of this hernia through a combined thoracoabdominal incision, which is particularly indicated for patients who have undergone previous diaphragmatic hernia surgeries or those with hernias that cannot be reduced manually. The approach allows for direct access to both the thoracic and abdominal cavities, facilitating the identification and management of the hernia sac, the diaphragm's muscular origins, and the esophageal hiatus. During the procedure, if a previous fundoplication has been performed, it is carefully taken down to allow for proper repair. The herniated stomach is then mobilized back into the abdominal cavity, and the hernia sac is excised while protecting the anterior vagus nerve. If a fundoplication is indicated, the fundus of the stomach may be wrapped around the esophagus and secured, utilizing various techniques such as Nissen or Toupet procedures. The diaphragm is subsequently repaired, either with sutures or reinforced with mesh or other prosthetic materials, ensuring a robust closure. Finally, the surgical sites in the abdomen and thorax are closed, and chest tubes may be placed as necessary to facilitate recovery.
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The procedure described by CPT® Code 43337 is indicated for the following conditions:
The surgical procedure for repairing a paraesophageal hiatal hernia via CPT® Code 43337 involves several critical steps:
Post-procedure care following the repair of a paraesophageal hiatal hernia includes monitoring for complications such as infection, bleeding, or respiratory issues due to the thoracic approach. Patients may require pain management and will be monitored for any signs of gastrointestinal obstruction. Recovery typically involves a gradual return to normal activities, with specific dietary modifications as advised by the healthcare provider. Follow-up appointments are essential to assess the surgical site and ensure proper healing.
| Short Descr | THORABD DIAPHR HERN REPAIR | Medium Descr | RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH | Long Descr | Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, 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. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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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