paraesophageal hernia with biologic mesh 43280 vs 43282

[Peterk50]

I am trying to find information on the specifics for these two CPT. I have a paraoesophageal hernia with biologic mesh repair, but the techniques was the surgeon just sutured to repair and did not dissect the hernia sack out. My question is the 43280 does not include mesh and the 43282 does, but the details are the hernia sac is dissected out. Just because the 43282 has with mesh can that code be used regardless whether the surgeon sutured repair and not dissected?

 

[cpc2007]

Can you post the body of the operative report without patient details for a complete review? It is possible the surgeon did not describe the dissection of the hernia sac in detail leading to the confusion. Alternatively, this may not be a paraesophageal hernia in the true sense of the word from a coding perspective.

A paraesophageal hernia repair would be coded with 43281 or 43282 when performed through a laparoscopic approach (43281 is without mesh and 43282 is with mesh). A paraesophageal hernia repair by definition require dissecting a hernia sac/the esophagus, reducing any herniated abdominal organs back below the diaphragam, and then a repair (either with sutures alone or with placement of a piece of mesh). CPT 43280 on the other hand is for a fundoplasty alone without a paraesophageal hernia repair when performed through a laparoscopic approach. In this procedure, the top of the stomach (the fundus) is wrapped around the lower esophagus, but no hernia repair is performed (this procedure typically addresses GERD which is not responding to medications).

There are also other procedures that are similar to a paraesophageal hernia repair but not coded with 43281/43282. The AMA addressed a Morgagni hernia repair in CPT Assist Dec. 2014 and stated that because dissection of the esophagus was not part of this procedure, and a Morgagni would consequently be an easier repair than that represented by 43281/43282, these codes should not be used to report a Morgagni repair, and instead, 49659 (unlisted) should be used instead. The NCCI policy manual, Chapter 6, section, F.10 also states that 43281/43282 shall not be reported for a figure of eight suture to close the hiatus/crura which is often performed in conjunction with another procedure such as a gastric restrictive procedure (again making it clear that suturing alone without dissection of the hernia sac/esophagus is not a true paraesophageal hernia repair and should not be coded with these CPT codes).

I hope this response helps a bit. Again, if you want to post the rest of the operative report without patient information, I am happy to review it and see if this is a situation where you need to send the note back to the surgeon to more fully describe what is a true paraesophageal hernia repair, or if he/she is describing something similar that would not fall under these codes.

Kim
www.codingmastery.com