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Hital Herina

  1. #1
    Location
    NEW ORLEANS
    Posts
    954
    Default Hital Herina
    Medical Coding Books
    I have been using cpt code 49659 for laparoscopy hital herina repair
    and not getting paid. Someone told me use cpt code 43280 . Is this correct ?

  2. #2
    Default Hiatal hernia
    Quote Originally Posted by trent123 View Post
    I have been using cpt code 49659 for laparoscopy hital herina repair
    and not getting paid. Someone told me use cpt code 43280 . Is this correct ?
    I think it depends on what's done. You will need to check the OP report, but the 43280 is accurate if they are doing a fundoplasty (Nissen etc.). The OP report is going to be what you go by though.
    This is the description of the fundoplasty:

    43280

    The physician performs an esophagogastric fundoplasty using a laparoscope. With the patient under anesthesia, the physician places a trocar at the umbilicus into the abdomen and insufflates the abdominal cavity. The physician places a laparoscope through the umbilical incision and additional trocars are placed into the peritoneal or space. Additional instruments are introduced through the trocars. The physician identifies the fundus and the esophagus and resects them. The fundus is wrapped around the lower end of the esophagus, which is rejoined to the stomach with sutures. The trocars are removed and the incisions are closed with sutures.

  3. #3
    Location
    NEW ORLEANS
    Posts
    954
    Default herina
    its with a lap band

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    since there currently is not a code for a laparoscopic hiatal hernia, the unlisted code is the correct code (but I think 43289 is the one you should be using rather than the 49659..). The unfortunate thing is that you will need to send in the documentation to the insurance carrier and cross reference the unlisted code with the appropriate open procedure code (39530??) in order to get paid.

    hope this helps
    Mary

  5. Default
    In most of our laparoscopic hiatal hernia repairs, there is at least a partial fundoplication done (altho you have to read thru the op note to find mention of it), and in those cases I use the 43280. When no fundo is done, I usually use 39599, since the open codes (39502 et al) are all in that section.
    C.Martin CPC-GENSG

  6. #6
    Default
    Has anyone ever had a Lap Hiatal Hernia Repair where the patient's stomach and transverse colon were in her chest?
    He spent about 3 1/2 hours taking down adhesions to reduce these back down out of the chest. I originally billed 43280-22 but he said this was not the procedure he did and that his procedure was much more extensive.
    Has anyone gotten payment for the unlisted code 43289? The patient has MCR and BCBS.
    Mary Beth Gord, CPC

  7. Smile Laparoscopic Hiatal Hernia repair code
    The code for this is
    43281 - w/o mesh
    43282 w/ mesh

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