General Surgery Coding Alert

Reader Question:

Check Payer Rules for GERD Procedure

Question: Our surgeon performed a laparoscopic esophageal sphincter augmentation by placing a magnetic band at the sphincter for a patient with GERD. During the procedure, the surgeon noted esophagitis related to a hiatal hernia, and he repaired the hernia with a mesh placement. How should we code this case to capture both procedures?

Georgia Subscriber

Answer: You should report the surgeon's work as 43284 (Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed).

You should not separately report the mesh placement, or cruroplasty, because the code descriptor includes that service, when performed.

Consider coverage: Some payers don't cover the sphincter augmentation procedure for patients with gastroesophageal reflux disease (GERD). But the payers may cover the hiatal hernia repair. In that case, you should report the appropriate code such as 43282 (Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh).

Bottom line: Under no circumstances would you code both 43284 and 43282 for the procedure you describe.