General Surgery Coding Alert

Question: Our surgeon performed a procedure to control the esophageal sphincter to treat a patient with GERD. The op note describes laparoscopic access to the lower esophageal sphincter with implantation of a “sphincter augmentation device.” Is this a fundoplication procedure that I should report with 43280?

Missouri Subscriber

Answer: No, the procedure you describe is considered an esophageal sphincter augmentation, which you should report as 43284 (Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed).

You are correct that the code for a laparoscopic fundoplasty is 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]), but that code doesn’t fit the procedure you describe.

Similar: The sphincter augmentation is similar to a fundoplasty in that it’s performed to enhance function of the esophageal sphincter to treat gastroesophageal reflux disease (GERD). But the two procedures use a different technique to control the sphincter.

Code 43284 involves the surgeon placing a device around the lower esophageal sphincter that is made up of magnetic beads that close around the sphincter, helping it to stay closed yet yield to pressure when the patient swallows.

In contrast, the fundoplication involves the surgeon reconstructing the lower esophageal sphincter by wrapping the fundus of the stomach around the sphincter and suturing it in place.