Tag Archives | Hernia Repair

Switch to 43327, 43328 for Esophagogastric Fundoplasty

Open or laparoscopic, through chest or abdominal wall, with or without hiatal hernia repair, with or without mesh … these are the various ways your surgeon might perform an esophagogastric fundoplasty. And these are the factors you’ll need to take into account when you try to pick the proper code(s) from among nine new choices in CPT 2011.

Let our experts show the way with four how-to tips for paraesophageal hiatalhernia repair and fundoplication coding for 2011.

Tip 1: Understand Pathophysiology

“When a patient is described as having a hiatal hernia, it usually means that part of the stomach has herniated through the opening in the diaphragm [esophageal hiatus] into the chest and is usually associated with esophageal reflux disease,” according to Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

The hernia repair typically involves the surgeon reducing the stomach back into the abdomen and suturing the enlarged diaphragmatic hiatus, explains M. Tray Dunaway, MD, FACS, CSP, a general surgeon and an educator with Healthcare Value Inc. in Camden, S.C.

During the fundoplication procedure, such as Nissen, the surgeon additionally wraps part of the fundus (top) of the stomach around the esophagus and sutured in place. This creates a “valve” that allows food to reach the stomach from the esophagus but prevents reflux back to the esophagus.

“I would say the Nissen fundoplication is the most common surgical procedure to treat gastroesophageal reflux disease (GERD),” Dunaway adds. Watch for gastroplasty: Sometimes the esophagus is shortened and the surgeon can’t reduce the hernia. “The surgeon might perform a gastroplasty, forming a tube of stomach to effectively elongate the distal esophagus,” Dunaway says. An example of such a procedure is a Collis gastroplasty.

Tip 2: Use 43332-43337 for Open…

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Surgical Coding: Follow Hernia Bundling Rules

Did you factor in a foreign body removal code?

Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the

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Surgery Coding: Look at Service Date Before Appending Modifier 59

Make sure your documentation supports the additional substantial complexity of the hernia repair and mesh.

Question: A patient presented for a colectomy for colon cancer. The physician also discovered that the patient had a ventral incarcerated hernia that required a

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Surgical Coding Mysteries: The Case of the Separate Mesh

Beware Separate Mesh Removal
Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair.
Excised […]

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