AHA Coding Clinic® for HCPCS - 2017 Issue 2; Ask the EditorA 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? ... Show To read the full article, sign in and subscribe to the AHA Coding Clinic® for HCPCS. Thank you for choosing Find-A-Code, please Sign In to remove ads. A hernia occurs when an organ or fatty tissues pushes through an abdominal opening. Surgery is performed to remove a hernia that grows larger or causes pain. Hernia repair is one of the most common surgeries performed in the United States, according to the Food and Drug Administration. Specialists in gastrointestinal surgery work with other physicians to repair hernia. Providers can rely on a gastroenterology medical billing expert to submit accurate claims and get reimbursed for their services. Hernia Types and Surgical Approaches There are different types of hernia such as inguinal hernia, femoral hernia, umbilical hernia, incisional or ventral hernia, epigastric hernia, and hiatal hernia.
Coding Hernia Repair, Mesh Implantation, and Mesh Removal According to an AAPC article, knowing how to differentiate hernia repairs and surgical approaches is important for correct medical coding. The two approaches for surgical hernia repair are: open and laparoscopic. A synthetic or prosthetic mesh is used to strengthen the repair in 90 percent of all hernia surgeries (AAPC). The 2019 CPT codes for hernia repair are as follows:
Hiatal Hernia Repair:
Parastomal Hernia Repair:
The AAPC article lists various scenarios for reporting “removal of mesh”:
Points to note:
Reporting hernia repair and abdominal reconstruction can be complex. Physicians need to ensure accurate and specific documentation so that coders and medical billing service providers can ensure accurate claim submission. A reliable gastroenterology medical billing company will work along with physicians to make sure that everything is submitted correctly according to payer policies. What is the CPT code for laparoscopic hiatal hernia repair?CPT codes 43280 (laparoscopic), 43325, 43327, 43328 (open) are the correct codes to report for an esophagogastric fundoplasty. Per CPT and NCCI, the esophagogastric fundoplasty includes any associated type I hiatal hernia repair; which is not reported separately.
Does CPT code 49560 include mesh?Placement of mesh (49568) is an add-on code for incisional or ventral hernia repairs, performed via an open approach. The range of codes that CPT®code 49568 may be reported with is 11004-11006, 49560—49566. The facility may bill for mesh in other cases, but there is not a separate physician charge.
What is the difference between CPT 43281 and 43282?Code paraesophageal hernia repairs by laparoscopic approach with 43281 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh or 43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of ...
What is the CPT code 43281?The Current Procedural Terminology (CPT®) code 43281 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Procedures on the Esophagus.
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