Wiki Lap Repair - We have a new Thoracic Surgeon

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GIBBERS

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Hi,
We have a new Thoracic Surgeon that is doing this Surgery. The Repair included a Nissen fundoplication and wedge gastroplasty.

I have found the CPT code 43281 that includes the hernia repair and fundoplication....but I can not find any Lap code for 'wedge gastroplasty'

I found an "open" code CPT 43326 - fundoplasty w/gastroplasty, but then, this open code does not include the hernia repair.

I am sure that someone has come across this before, as my Surgeon has done 2 of the surgeries in the last week.

I would appreciate any help that you can give me..
Thanks so much!
Terri
 
The Lap code you are looking for, I believe, is 43280. It shows as a coding error if we try to code the hernia repair with it, saying the hernia repair is secondary and not payable in this case.

As far as the "wedge gastroplasty", the CVTs I work with have never used this term before and when I search it I'm getting gastric bypass codes. Is that what they are doing? We don't do that here so I don't know much about it.

Hopefully this is somewhat helpful,

Laura, CPC, CPMA, CEMC
 
The open code 43326 does include the hernia repair, that is what a fundoplication basically is. It can be confusing because CPT has two sets of codes for hiatal hernia repair (diaphragm section 39000 and esophagus 43000). You can use either but the fundoplication codes pay better.

The Society of Thoracic Surgeons specifically mentioned a lap wedge gastroplasty at their coding workshop, they advised to bill the lap fundoplasty code 43280 for all the fundoplications (ie: Hill, Nissen, Toupet, Dor).

Lisi, CPC
eharkler@nmh.og
 
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