General Surgery Coding Alert

Maintain status quo for lap fundoplication coding.

CPT 2011 adds nine new codes for open hiatal hernia repair and esophagogastric fundoplication, but codes for comparable laparoscopic procedures remain the same -- except for one new add-on code you should know about.

Pull down the pay you deserve with this how-to laparoscopic coding review -- and learn how to add +43283 (Laparoscopy, surgical, esophageal lengthening procedure [e.g., Collis gastroplasty or wedge gastroplasty] [List separately in addition to code for primary procedure]) to your laparoscopic coding tool box.

Retain 43281-43282 for Lap Hiatal Hernia Repair With/Without Fundoplication

If your surgeon performs a laparoscopic hiatal hernia repair, you should choose the appropriate code based on whether the surgeon implants mesh as part of the procedure, as follows:

• 43281 -- Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh
• 43282 -- ... with implantation of mesh.

You'll see higher pay for the procedure with mesh placement: $1,575.15 for 43281 versus $1,769.83 for 43282 (based on Medicare physician fee schedule national facility amount using conversion factor 33.9764).

Here's why: "Placing mesh takes more time and increases the risk of infection," explains M. Tray Dunaway, MD, FACS, CSP, a general surgeon and an educator with Healthcare Value Inc. in Camden, S.C.

Laparoscopic Nissen fundoplasty is more common than open, because "it carries a faster recovery time and costs less to perform," according to Dunaway.

Lap 'Fundoplication Only' Still Takes 43280

If your surgeon performs a laparoscopic fundoplication without hiatal hernia repair, you should code the service as 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures).

Add +43283 for Lap Esophageal Lengthening

If a patient has a shortened esophagus that precludes reducing a hiatal hernia, the surgeon may need to perform a gastroplasty to effectively lengthen the esophagus, according to Dunaway.

CPT 2011 provides a new add-on code to capture the additional gastroplasty service -- +43283. A new text note instructs you to use the code in conjunction with 43280, 43281, or 43282.

For example: If the surgeon performs a laparoscopic paraesophageal hernia repair with fundoplication and Collis gastroplasty without mesh placement, report 43281 and +43283.

Old way: Prior to Jan. 1, you would have reported this laparoscopic Collis-Nissen surgery using unlisted code: 43289 (Unlisted laparoscopy procedure, esophagus).