- Messages
- 6
- Location
- Nacogdoches, TX
My provider is stating a hiatal hernia is a paraesophageal hernia and this case should be coded as 43281. I am recommending 43280. I do understand that her statement is correct on a general level, however from the research I found there is a difference between them. 43280 is for type I sliding hiatal hernia repair: the connection between the esophagus and stomach moves up into the chest, often slips back & forth on its own. While 43281 is for a paraesophageal (type II, III or IV): the junction stays below the diaphragm and part of the stomach rolls up beside the esophagus.
Any assistance or advice would be greatly appreciated. Thank you!
Here is the op note:
Pre-Operative Diagnosis:
HIATAL HERNIA, GERD
Post-Operative Diagnosis:
HIATAL HERNIA, GERD
Description of Procedure(s):
She was brought to the operating room position the operative table in supine position a timeout was performed she underwent general endotracheal anesthesia she received subcutaneous Lovenox and IV antibiotics prior to any skin incisions. Her arms were secured to the armboard and the foot were placed. Her abdomen was prepped vaccine draped using sterile technique. A small skin incision was made in the left upper quadrant and a Veress needle inserted low opening pressures and insufflated to a level 12 mm this was then exchanged with an 8mm robotic trocar . 3 additional trochars were placed in the upper abdomen approximately 15 cm from the xiphoid process in the mid rectus position on the right side of the abdomen a 12 mm trocar was placed in a midrectus position on the left and two 8mm robotic trocars were placed in the right upper quadrant also under direct visualization. A small skin incision was made in the epigastrium and the Nathanson liver retractor inserted under direct visualization used to hold the liver and static retraction towards the anterior abdominal wall exposing a moderate size hiatal hernia. At that point she was placed in reverse Trendelenburg position. The robot was docked over her right shoulder. The gastrohepatic ligament was opened up to the right crus and the hernia sac was dissected around anteriorly over the to theleft crus. The stomach was then pulled over towards the liver the greater curvature was divided up to the level of the left crus which also was dissected anteriorly to meet the anterior dissection. the stomach was then pulled over laterally towards the spleen and the posterior dissection was performed bluntly this was then continued circumferentially up into the mediastinum into the esophagus was lying down in the abdomen without retraction for approximately 3 cm. the crura were reapproximated in a posterior fashion with 3 interrupted figure-of-eight sutures. One single suture was placed in the anterior side of the overall Surgidac sutures A Nissen was then performed by wrapping the stomach posteriorly and the stomach was sitting without any retraction and it was secured around the esophagus using Surgidac suture again ×3 The Nathanson was then removed under direct visualization the 12 mm trocar removed and the fascia closed with an 0 Vicryl suture using a Weck fx fascial closure device. The abdomen was completely desufflated all trochars removed all skin incisions closed with 4-0 Monocryl covered with Dermabond skin glue. She tolerated the procedure well blood loss was minimal she was transferred to PACU in stable condition
Any assistance or advice would be greatly appreciated. Thank you!
Here is the op note:
Pre-Operative Diagnosis:
HIATAL HERNIA, GERD
Post-Operative Diagnosis:
HIATAL HERNIA, GERD
Description of Procedure(s):
She was brought to the operating room position the operative table in supine position a timeout was performed she underwent general endotracheal anesthesia she received subcutaneous Lovenox and IV antibiotics prior to any skin incisions. Her arms were secured to the armboard and the foot were placed. Her abdomen was prepped vaccine draped using sterile technique. A small skin incision was made in the left upper quadrant and a Veress needle inserted low opening pressures and insufflated to a level 12 mm this was then exchanged with an 8mm robotic trocar . 3 additional trochars were placed in the upper abdomen approximately 15 cm from the xiphoid process in the mid rectus position on the right side of the abdomen a 12 mm trocar was placed in a midrectus position on the left and two 8mm robotic trocars were placed in the right upper quadrant also under direct visualization. A small skin incision was made in the epigastrium and the Nathanson liver retractor inserted under direct visualization used to hold the liver and static retraction towards the anterior abdominal wall exposing a moderate size hiatal hernia. At that point she was placed in reverse Trendelenburg position. The robot was docked over her right shoulder. The gastrohepatic ligament was opened up to the right crus and the hernia sac was dissected around anteriorly over the to theleft crus. The stomach was then pulled over towards the liver the greater curvature was divided up to the level of the left crus which also was dissected anteriorly to meet the anterior dissection. the stomach was then pulled over laterally towards the spleen and the posterior dissection was performed bluntly this was then continued circumferentially up into the mediastinum into the esophagus was lying down in the abdomen without retraction for approximately 3 cm. the crura were reapproximated in a posterior fashion with 3 interrupted figure-of-eight sutures. One single suture was placed in the anterior side of the overall Surgidac sutures A Nissen was then performed by wrapping the stomach posteriorly and the stomach was sitting without any retraction and it was secured around the esophagus using Surgidac suture again ×3 The Nathanson was then removed under direct visualization the 12 mm trocar removed and the fascia closed with an 0 Vicryl suture using a Weck fx fascial closure device. The abdomen was completely desufflated all trochars removed all skin incisions closed with 4-0 Monocryl covered with Dermabond skin glue. She tolerated the procedure well blood loss was minimal she was transferred to PACU in stable condition