AHA Coding Clinic® for HCPCS - 2017 Quarter 2; Ask the Editor
Laparopscpic redo hiatal hernia repair
A patient with a history of a hiatal hernia repair and Nissen fundoplication in 2013 was seen at our facility and found to have a recurrent hiatal hernia with dysphagia and reflux, twisting of the distal esophagus and an extremely loose fundoplication. In order to get good visualization of the hiatus as well as to get a better fundoplication, the previous fundoplication had to be taken down. A GIA stapler was inserted and fired across the previous fundoplication as close to the suture line as possible. Once the crural stitch had been placed, a 10 x 10 sheet of biologic mesh was placed. Fundoplication was then performed using 0 Silk and Ti-Knot. The plication appeared loose and the clamp passed through it easily. Posterior wrap was then secured to the crura with a single stitch. Our Encoder directs us to Unlisted CPT code 43289 for a revision and/or takedown. Some of our coders agree with this because the procedure involves more than the description of 43282 . Others feel 43282 is appropriate. What is the CPT code(s) to use for a Laparoscopic Re-do hiatal hernia repair with patch reinforcement and Fundoplication? ...
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Article Overview
This premium article reviews a postoperative revisional upper gastrointestinal surgical scenario involving recurrent hiatal hernia, prior fundoplication, mesh placement, and redo wrap repair. It is intended to help coders and billers evaluate the appropriate CPT coding approach when a repeat laparoscopic repair does not map cleanly to a standard listed code and an unlisted CPT code is considered. The discussion is relevant to surgical coding professionals working with foregut, general surgery, and complex reoperative cases.
Why This Topic Matters
Reoperative foregut procedures can be difficult to code because the operative work may differ substantially from a primary repair. Understanding when an unlisted CPT pathway is used helps support accurate claim submission and documentation review.
What You Will Learn
- How the article frames coding for a redo laparoscopic hiatal hernia repair
- Why revisional fundoplication cases can require special coding review
- What general factors are highlighted when an unlisted CPT code is considered for a revision procedure
- How the operative scenario is characterized for coding and documentation purposes
Who Should Read This
- CPT coders
- Surgical billers
- Coding auditors
- General surgery coding staff
- Revenue cycle professionals
Codes Discussed
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