How To Use CPT Code 43336

CPT 43336 describes the repair of a paraesophageal hiatal hernia, including fundoplication, through a thoracoabdominal incision, without the use of mesh or other prosthesis. 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 43336?

CPT 43336 is used to describe the surgical repair of a paraesophageal hiatal hernia, which occurs when the stomach slides up next to the esophagus. The procedure involves making an incision in the abdomen and chest to access the hernia and perform the repair. It also includes fundoplication, which is the wrapping of the gastric fundus (upper part of the stomach) around the esophagus to treat gastroesophageal reflux. This code does not involve the use of mesh or other prosthetic implantation and is not appropriate for newborns.

2. Official Description

The official description of CPT code 43336 is: ‘Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis.’

3. Procedure

1. The surgeon makes an incision in the abdomen and chest to access the hiatus, the opening in the diaphragm where the esophagus passes through.
2. Any adhesions are removed, and the part of the stomach that has moved into the chest is separated from the hernia sac.
3. The surgeon ensures that the stomach is in the abdominal cavity and may use sutures to narrow the enlarged diaphragmatic esophageal hiatus.
4. 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 surgeon removes any instruments used, controls bleeding, and closes the incision.

4. Qualifying circumstances

CPT 43336 is performed on patients with a paraesophageal hiatal hernia, where the stomach slides up next to the esophagus. This condition is characterized by an upward herniation of the gastric fundus into the chest. The procedure is appropriate for patients who do not require the use of mesh or other prosthetic implantation. It is not performed on newborns.

5. When to use CPT code 43336

CPT code 43336 should be used when a surgeon performs a repair of a paraesophageal hiatal hernia, including fundoplication, through a thoracoabdominal incision, without the use of mesh or other prosthesis. It is important to ensure that the patient meets the qualifying circumstances for this procedure and that no other codes are more appropriate for the specific case.

6. Documentation requirements

To support a claim for CPT 43336, the surgeon must document the following information:

• Patient’s diagnosis of paraesophageal hiatal hernia
• Description of the repair procedure performed, including details of the thoracoabdominal incision and the absence of mesh or other prosthetic implantation
• Date of the procedure
• Any additional findings or procedures performed during the surgery
• Any complications or unexpected events encountered
• Signature of the surgeon

7. Billing guidelines

When billing for CPT 43336, ensure that the procedure meets the specific criteria outlined in the code description. The use of mesh or other prosthetic implantation should be documented separately if performed. It is important to review the documentation requirements and guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 43336 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 billing purposes.

9. Examples

1. A surgeon performs a repair of a paraesophageal hiatal hernia, including fundoplication, through a thoracoabdominal incision, without the use of mesh or other prosthesis.
2. A patient with a paraesophageal hiatal hernia undergoes a thoracoabdominal repair procedure with fundoplication to alleviate symptoms of gastroesophageal reflux.
3. A surgeon performs a thoracoabdominal incision to repair a paraesophageal hiatal hernia and performs fundoplication to prevent the recurrence of symptoms.
4. A patient with a paraesophageal hiatal hernia undergoes a surgical repair procedure that includes fundoplication to address complications such as chest pain and difficulty swallowing.
5. A surgeon performs a repair of a paraesophageal hiatal hernia through a thoracoabdominal incision, ensuring the stomach is properly positioned and performing fundoplication to treat gastroesophageal reflux disease.
6. A patient with a paraesophageal hiatal hernia undergoes a thoracoabdominal repair procedure with fundoplication to improve their quality of life and alleviate symptoms such as heartburn and regurgitation.