Nissen and Paraesophageal hernia repair

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Good Afternoon!

Doc and compliance department are in disagreement and.....I am not sure....so I hope someone can point me in the right direction.

There is a cpt code for lab nissen - 43280; however, not one for paraesophageal hernia repair so doc is using unlisted code.

CCI edits do not have edits for these procedures, but it does talk about OPEN hernia's not being coded separately from other open abdominal surgeries.

Compliance department is stating that due to this CCI commentary ALL hernias are included in the fundoplication whether it is open or lap.

We have a general surgery news letter that is confusing and the article sounds as if it is contradicting itself.

My head is spinning...are we sure it's not Friday yet?

So can a fundoplication be coded separately from the paraesophageal hernia repair...both done via lap?
 

LLovett

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I would code both, using the unlisted code for the hernia.

You are going to have to send in documentation, there are no guidelines attached to the unlisted code other than only using it when no other code applies (which there isn't at this time).

Where is the harm in that? Either insurance will consider it or they will reject it.

I don't see this as a compliance issue myself. He did a procedure that doesn't have a cpt code therefore doesn't have any CCI edits attached. It doesn't matter what they say about other hernia procedures, that wasn't the surgery that was done.

Just my opinion,

Laura, CPC
 
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kprovance

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below is an exerpt from General Surgery Coding Alert 2008 Volume 11 Number 2

Select 39502/39599 for Paraesophageal Hernia

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 operative report for documentation that describes migration and potential strangulation of the fundus of the stomach.

For open paraesophageal 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 paparaesophageal repair, and you should code for only 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.




I hope this has helped.
 
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225
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Modesto, CA; Central Valley Chapter
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Thanks to both responses. The problem is getting our compliance department to establish a charge amount so that it can be billed.

The general surgery news letter is something that I have used to support the coding of both.

Thanks again!
 
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