Wiki Laparoscopic hiatal hernia

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lindacoder said:
I know this has probably been addressed before but I need to code a laparoscopic hiatal hernia repair. Any input is appreciated!!
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Please, read the following info regarding Laparascopic Hiatal Hernia Repair.
There is a HUGE difference between a paraesophageal hernia and a hiatal hernia, so beware of codes already suggested in your post.

General Surgery Coding Alert 2008, Volume 11, Number 12

A paraesophageal hernia is a far more serious condition than a regular hiatal hernia, and you must learn how coding differs for these repairs. To identify a paraesophageal hernia, search the op report for documentation that describes migration and potential strangulation of the fundus of the stomach.

For open esophageal repair, you should report 39502 (Repair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy and/or pyloroplasty, except neonatal). Note that this is the only hiatal hernia repair (other than the hernia repair described in the nissen procedure) that uses only an abdominal approach.

Pay attention: While performing a Nissen, the surgeon may encounter an enlarged diaphragmatic hiatus and subsequently reduce the hiatus size. You should not consider this a paraesophageal repair, and you should code only for the nissen procedure.

For a laparascopic paraesophageal repair, you must resort once again to 39599 because CPT does not contain a specific code to describe this procedure.

This is some more info on the Lap hiatal hernia codes, this one is for the 2010 code set:

Question: In accordance with the new laparoscopic hernia codes, does 49652 incorporate the hiatal hernia repair? I was told that epigastric hernia repair is the same, but our surgeon does not agree. What is the correct code to use for laparoscopic repair of hiatal hernia?

Answer: CPT does not contain a specific code to describe laparoscopic hiatal hernia repair, even with the addition of the new laparoscopic hernia repair codes this year. Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).

If the surgeon performed an open hiatal hernia repair, however, you would select 39520 (Repair, diaphragmatic hernia [esophageal hiatal]; transthoracic) for a transthoracic approach, or choose between 39530 (…combined, thoracoabdominal) and 39531 (… combined, thoracoabdominal, with dilation of stricture [with or without gastroplasty]), as appropriate.

Clinical rationale: Your surgeon is correct that an epigastric hernia is not the same as a hiatal hernia. An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where the esophagus transits the chest cavity to the abdominal cavity.
 
We use unlisted code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) to represent the laparoscopic hiatal hernia repair. I understand the code indicated above is of the diaphragm, but the 49659 is for hernia's and is specifically laparoscopic; therefore, we chose to use this code rather than 39599 (Unlisted procedure, diaphragm). We use the unlisted procedure code when all they do is reduce the hernia and suture the left and right crura.

If they do fundoplication, the hiatal hernia repair is included in the 43280 (Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)). See info in the CPT(R) Assistant Detail, Year: 2012, Issue: February, Pages: 3-7, Title: Repair, Paraesophageal Hiatal Hernia (Including Fundoplication) and also Year: 2002, Issue: December, Pages: 1, Title: Laparoscopic Nissen Fundoplasty. The last article listed specifically states, " The procedure (43280) also includes repair of coexisting hiatal hernia, a common occurrence in these cases".

A. Farmer, CPC
General Surgery​
 
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