General Surgery Coding Alert

What passes through hiatus is key.

You can’t pick the proper hernia repair CPT^® code if you don’t understand the different hiatal hernia types. That’s why we’ve put together this hiatal hernia briefing for your review.

All hiatal hernias involve “herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm,” states Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

These elements migrate into the mediastinum and cause various symptoms and pathologies. But it’s an understanding of what passes through the hiatus — not the pathology it causes — that provides the basis of classifying hiatal hernias.

Focus on ‘Types’

Current hiatal hernia classification breaks the condition down into four “types.” The first is:

·         Type I: These hernias involve the gastroesophageal (GE) junction migrating through the diaphragmatic hiatus into the mediastinum. These are also known as “sliding” hiatal hernias.

All other hiatal hernia types involve a “paraesophageal” hernia — when abdominal contents other than just the GE junction move through the hiatus into the mediastinum. These paraesophageal hernias are classified into the following types:

·         Type II: In these hernias, the GE junction remains fixed, but the gastric fundus herniates through the hiatus into the mediastinum.

·         Type III: These paraesophageal hernias involve elements of both Type I and Type II.

·         Type IV: When a large defect allows other organs — such as colon, pancreas, or small intestine — to enter the hernia sac through the hiatus, it’s classified as type IV.