How To Use CPT Code 43281

CPT 43281 is a surgical procedure code for laparoscopic repair of paraesophageal hernia without mesh implantation. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 43281 procedures.

1. What is CPT 43281?

CPT 43281 is a medical billing code used to describe a laparoscopic surgical procedure for the repair of a paraesophageal hernia without the implantation of mesh. This code is used by medical coders and billers to accurately report and bill for this specific procedure.

2. 43281 CPT code description

The official description of CPT code 43281 is: “Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh.”

3. Procedure

The 43281 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. A small incision is made at the umbilicus, and the abdomen is insufflated with gas to improve visualization.
3. Additional small incisions are made to insert a camera and instruments for the procedure.
4. Adhesions are taken down, and the surgical site is visualized.
5. The esophagus, stomach, and diaphragm are identified, including the hiatus.
6. Any displaced stomach or intestines are returned to their normal anatomic positions below the diaphragm.
7. The diaphragmatic defect is repaired, and the hernia sac is eliminated.
8. If fundoplasty is performed, the fundus is incised and wrapped around the distal esophagus, then stitched in place.
9. Hemostasis is assured, and the small abdominal incisions are closed in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 43281 services are those diagnosed with a paraesophageal hernia, where the stomach slides up next to the esophagus. This condition can cause symptoms such as heartburn, difficulty swallowing, and chest pain. The procedure is typically recommended for patients who have not responded to conservative treatments, such as medication and lifestyle changes, or for those with severe or life-threatening complications.

5. When to use CPT code 43281

It is appropriate to bill the 43281 CPT code when a provider performs a laparoscopic repair of a paraesophageal hernia without the implantation of mesh. This includes cases where fundoplasty is performed as part of the procedure. The code should not be used for procedures involving mesh implantation, as there is a separate code for that (CPT 43282).

6. Documentation requirements

To support a claim for CPT 43281, the following information should be documented in the patient’s medical record:

• A clear diagnosis of paraesophageal hernia
• Indication of conservative treatments tried and their outcomes
• Details of the surgical procedure, including the steps performed and any complications encountered
• Confirmation that mesh was not implanted during the procedure
• Postoperative care instructions and follow-up plans

7. Billing guidelines

When billing for CPT code 43281, it is essential to ensure that the procedure is accurately documented and supported by the patient’s medical record. Additionally, be aware of any payer-specific guidelines or requirements for billing this code. It is also important to verify if any modifiers are needed to accurately report the service provided. For example, if the procedure is performed bilaterally, the appropriate bilateral modifier should be appended to the code.

8. Historical information

CPT 43281 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates to the code since its addition.

9. Similar codes to CPT 43281

Five similar codes to CPT 43281 and how they differ are:

• CPT 43282: This code is used for laparoscopic repair of paraesophageal hernia with mesh implantation.
• CPT 43280: This code describes a laparoscopic esophagogastric fundoplasty procedure.
• CPT 43289: This code is for laparoscopic esophageal lengthening procedure (Collis gastroplasty).
• CPT 43270: This code is for laparoscopic esophagomyotomy, which involves cutting the muscle of the esophagus to treat achalasia.
• CPT 43246: This code is for laparoscopic placement of a gastrostomy tube.

10. Examples

Here are 10 detailed examples of CPT code 43281 procedures:

1. A 55-year-old patient with a large paraesophageal hernia causing severe heartburn undergoes laparoscopic repair without mesh implantation.
2. A 65-year-old patient with a history of chronic gastroesophageal reflux disease (GERD) undergoes laparoscopic repair of a paraesophageal hernia, including fundoplasty, without mesh implantation.
3. A 45-year-old patient with a paraesophageal hernia causing chest pain and difficulty swallowing undergoes laparoscopic repair without mesh implantation.
4. A 70-year-old patient with a paraesophageal hernia and a history of aspiration pneumonia undergoes laparoscopic repair without mesh implantation.
5. A 60-year-old patient with a paraesophageal hernia causing severe anemia due to chronic blood loss undergoes laparoscopic repair without mesh implantation.
6. A 50-year-old patient with a paraesophageal hernia causing recurrent episodes of vomiting undergoes laparoscopic repair without mesh implantation.
7. A 40-year-old patient with a paraesophageal hernia causing severe weight loss undergoes laparoscopic repair without mesh implantation.
8. A 75-year-old patient with a paraesophageal hernia causing shortness of breath undergoes laparoscopic repair without mesh implantation.
9. A 62-year-old patient with a paraesophageal hernia causing recurrent episodes of regurgitation undergoes laparoscopic repair without mesh implantation.
10. A 58-year-old patient with a paraesophageal hernia causing persistent cough undergoes laparoscopic repair without mesh implantation.