General Surgery Coding Alert

Question: Which code should I report for a laparoscopic paraesophageal hernia repair? The only thing I can find is unlisted procedure code 49659. Arizona Subscriber Answer: Paraesophageal hernia is a severe form of hiatal hernia, which involves migration of the fundus of the stomach and can result in subsequent strangulation of the fundus. You are correct that CPT does not contain a precise code for this procedure. Rather than 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy), however, you should instead select 39599 (Unlisted procedure, diaphragm). Here's why: CPT assigns a diaphragm repair code (39502, Repair, paraesophageal hiatus hernia, transabdominal, with our without fundoplasty, vagotomy and/or pyloroplasty, except neonatal) to describe an "open" paraesophageal hiatal hernia repair. Reduction of the hernia and contents from the thoracic cavity characterizes this as a diaphragmatic (rather than abdominal) repair. As such, an unlisted code describing diaphragm repair is likewise the best choice for the unlisted laparoscopic procedure in this case.