How To Use CPT Code 43280

CPT code 43280 describes a laparoscopic surgical procedure known as esophagogastric fundoplasty. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43280?

CPT 43280 is a code used to describe a laparoscopic surgical procedure called esophagogastric fundoplasty. This procedure involves wrapping the upper part of the stomach around the lower part of the esophagus to treat gastroesophageal reflux. It is typically performed for patients who have not responded to other forms of treatment.

2. Official Description

The official description of CPT code 43280 is: ‘Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures).’ This code should not be reported in conjunction with codes 43279, 43281, or 43282. For open esophagogastric fundoplasty, refer to codes 43327 and 43328. For laparoscopic esophageal sphincter augmentation procedures, use codes 43284 and 43285. For esophagogastroduodenoscopy fundoplasty, partial or complete, transoral approach, use code 43210.’

3. Procedure

1. The provider begins by making small incisions, including one at the umbilicus, to access the abdomen.
2. Carbon dioxide gas is then used to inflate the abdomen, creating space for the procedure.
3. A camera and instruments are inserted through the incisions to visualize and manipulate the organs.
4. Any adhesions are carefully taken down to ensure clear visibility.
5. The provider identifies the esophagus and stomach and, if necessary, repositions them to their normal anatomical positions.
6. The fundus of the stomach is incised and wrapped around the distal esophagus.
7. The provider secures the wrapped structures in place with sutures.
8. Hemostasis is ensured, and the small incisions are closed in layers.

4. Qualifying circumstances

CPT code 43280 is used for patients with gastroesophageal reflux who have not responded to other treatments. The procedure is performed laparoscopically by a qualified provider. It should not be reported in conjunction with certain other codes, as specified in the official description.

5. When to use CPT code 43280

CPT code 43280 should be used when a laparoscopic esophagogastric fundoplasty procedure is performed. It is appropriate for patients with gastroesophageal reflux who have not responded to other treatments. This code should not be used in conjunction with codes 43279, 43281, or 43282, as specified in the official description.

6. Documentation requirements

To support a claim for CPT code 43280, the provider must document the following information:

• Patient’s diagnosis of gastroesophageal reflux
• Details of the laparoscopic esophagogastric fundoplasty procedure performed
• Date of the procedure
• Start and end times of the procedure
• Any additional procedures or interventions performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 43280, ensure that the procedure is performed laparoscopically and meets the criteria outlined in the official description. Do not report this code in conjunction with codes 43279, 43281, or 43282. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT code 43280 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with severe gastroesophageal reflux undergoes a laparoscopic esophagogastric fundoplasty to alleviate their symptoms.
2. A provider performs a laparoscopic Nissen procedure on a patient with chronic gastroesophageal reflux who has not responded to medication.
3. A laparoscopic Toupet procedure is performed on a patient with gastroesophageal reflux and a hiatal hernia.
4. A laparoscopic esophagogastric fundoplasty is performed on a patient with gastroesophageal reflux and a history of failed conservative treatments.
5. A provider performs a laparoscopic fundoplasty to treat a patient with gastroesophageal reflux and associated complications.
6. A laparoscopic esophagogastric fundoplasty is performed on a patient with gastroesophageal reflux and symptoms that significantly impact their quality of life.
7. A patient with gastroesophageal reflux and a history of failed medication treatments undergoes a laparoscopic fundoplasty to improve their symptoms.
8. A provider performs a laparoscopic Nissen procedure on a patient with gastroesophageal reflux and a hiatal hernia.
9. A laparoscopic Toupet procedure is performed on a patient with gastroesophageal reflux and symptoms that are not adequately controlled with medication.
10. A laparoscopic esophagogastric fundoplasty is performed on a patient with gastroesophageal reflux and complications such as esophagitis or Barrett’s esophagus.