How To Use CPT Code 43334

CPT 43334 describes the repair of a paraesophageal hiatal hernia, including fundoplication, through a thoracotomy incision. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43334?

CPT 43334 is used to describe the surgical repair of a paraesophageal hiatal hernia, which occurs when the stomach slides up next to the esophagus. This procedure includes fundoplication, which involves wrapping the upper portion of the stomach around the esophagus to treat gastroesophageal reflux. The repair is performed through a thoracotomy incision, which is a surgical incision made in the chest wall.

2. Official Description

The official description of CPT code 43334 is: ‘Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis.’

3. Procedure

1. The provider makes an incision in the chest, typically on the left side, to access the hernia and the hiatus, which is the opening in the diaphragm where the esophagus passes through.
2. Any adhesions are removed, and the provider separates the stomach from the hernia sac.
3. The provider ensures that the stomach is in the abdominal cavity and may use sutures to narrow the enlarged diaphragmatic esophageal hiatus.
4. Complete fundoplication is performed by attaching the upper portion of the stomach (fundus) over the uppermost part of the gastroesophageal (GE) junction with sutures. The fundus may wrap completely or partially around the esophagus.
5. The provider controls any bleeding, places a chest tube, and closes the thoracotomy incision.

4. Qualifying circumstances

CPT 43334 is appropriate for patients with a paraesophageal hiatal hernia that requires surgical repair. This code should not be used for neonates. The procedure is performed by a provider through a thoracotomy incision, and it does not involve the implantation of mesh or other prosthetic materials.

5. When to use CPT code 43334

CPT code 43334 should be used when a provider performs a thoracotomy incision to repair a paraesophageal hiatal hernia, including fundoplication, without the use of mesh or other prosthetic materials. This code is not appropriate for neonates.

6. Documentation requirements

To support a claim for CPT 43334, the provider must document the following information:

• Patient’s diagnosis of paraesophageal hiatal hernia
• Description of the procedure performed, including the thoracotomy incision and the absence of mesh or other prosthetic materials
• Date of the procedure
• Any additional details relevant to the specific case

7. Billing guidelines

When billing for CPT 43334, ensure that the procedure meets the criteria outlined in the official description. The provider should perform a thoracotomy incision and repair a paraesophageal hiatal hernia, including fundoplication, without the use of mesh or other prosthetic materials. It is important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 43334 was added to the Current Procedural Terminology system on January 1, 2011. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes a thoracotomy incision for the repair of a paraesophageal hiatal hernia, including fundoplication, without the use of mesh or other prosthetic materials.
2. A provider performs a thoracotomy incision to repair a paraesophageal hiatal hernia and performs fundoplication without the use of mesh or other prosthetic materials.
3. During a surgical procedure, a thoracotomy incision is made to repair a paraesophageal hiatal hernia, and fundoplication is performed without the use of mesh or other prosthetic materials.
4. A patient with a paraesophageal hiatal hernia undergoes a thoracotomy incision for repair, including fundoplication, without the use of mesh or other prosthetic materials.
5. A provider performs a thoracotomy incision to repair a paraesophageal hiatal hernia and performs fundoplication without the use of mesh or other prosthetic materials.
6. During a surgical procedure, a thoracotomy incision is made to repair a paraesophageal hiatal hernia, and fundoplication is performed without the use of mesh or other prosthetic materials.
7. A patient with a paraesophageal hiatal hernia undergoes a thoracotomy incision for repair, including fundoplication, without the use of mesh or other prosthetic materials.
8. A provider performs a thoracotomy incision to repair a paraesophageal hiatal hernia and performs fundoplication without the use of mesh or other prosthetic materials.
9. During a surgical procedure, a thoracotomy incision is made to repair a paraesophageal hiatal hernia, and fundoplication is performed without the use of mesh or other prosthetic materials.