How To Use CPT Code 43333

CPT 43333 describes a specific surgical procedure used to repair a paraesophageal hiatal hernia. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes to CPT 43333.

1. What is CPT Code 43333?

CPT 43333 is a code used to describe a surgical repair procedure for a paraesophageal hiatal hernia. This procedure involves the use of a laparotomy, which is an abdominal incision, to access and repair the hernia. It may also include the implantation of mesh or another prosthesis to reinforce the repair. It is important to note that this code is not appropriate for newborns.

2. Official Description

The official description of CPT code 43333 is: ‘Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis.’

3. Procedure

1. The surgeon makes an abdominal incision, typically through the middle of the flank, to access the hernia site.
2. The liver is mobilized to visualize the hiatus, which is the opening in the diaphragm where the esophagus passes through.
3. Any adhesions are removed to clear the area.
4. The surgeon separates the stomach from the hernia sac and ensures that the stomach is properly positioned in the abdominal cavity.
5. If necessary, the surgeon may dilate the passage using an esophageal cone-shaped tube or bougie.
6. To prevent hernia recurrence, the surgeon prepares and secures mesh or a prosthesis of suitable size to narrow the opening.
7. The surgeon performs fundoplication by attaching the upper portion of the stomach to the uppermost part of the esophagus with sutures.
8. After completing the procedure, the surgeon removes any instruments or devices, controls bleeding, and closes the laparotomy incision.

4. Qualifying circumstances

CPT 43333 is used for patients with a paraesophageal hiatal hernia, where the stomach slides up next to the esophagus through a weakness in the diaphragm. This procedure is performed via laparotomy, except for neonatal cases. The use of mesh or another prosthesis for reinforcement is also a qualifying circumstance for this code.

5. When to use CPT code 43333

CPT code 43333 should be used when a surgeon performs a repair procedure for a paraesophageal hiatal hernia via laparotomy, except for neonatal cases. The use of mesh or another prosthesis for reinforcement is also a determining factor for the use of this code.

6. Documentation requirements

To support a claim for CPT 43333, the surgeon must document the following information:

• Patient’s diagnosis of a paraesophageal hiatal hernia
• Details of the laparotomy procedure, including the specific approach and any additional techniques used
• Description of the repair, including the use of mesh or another prosthesis
• Any complications or additional procedures performed
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 43333, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any additional techniques or materials used, such as mesh or a prosthesis. It is also essential to follow any specific billing guidelines provided by the payer or coding guidelines. Additionally, review the code range for repair procedures on the esophagus (43300-43425) to ensure the most appropriate code selection.

8. Historical information

CPT 43333 was added to the Current Procedural Terminology system on January 1, 2011. It has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A surgeon performs a laparotomy to repair a paraesophageal hiatal hernia and uses mesh for reinforcement.
2. During a laparotomy, a surgeon repairs a paraesophageal hiatal hernia and performs a complete fundoplication.
3. A patient undergoes a laparotomy procedure for the repair of a paraesophageal hiatal hernia, and a prosthesis is implanted for reinforcement.
4. A surgeon performs a laparotomy to repair a paraesophageal hiatal hernia and uses mesh for reinforcement, along with an esophageal lengthening procedure.
5. During a laparotomy, a surgeon repairs a paraesophageal hiatal hernia and performs a partial fundoplication, without the use of mesh or a prosthesis.