2025 CPT code 43280
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Laparoscopic esophagogastric fundoplasty (e.g., Nissen, Toupet procedures).
Modifiers may be applicable depending on the specific circumstances of the procedure. Consult the CPT manual and current payer guidelines for information on modifier use.
Medical necessity for 43280 is established when a patient has symptomatic GERD refractory to appropriate medical management, demonstrating persistent symptoms despite optimal medical therapy.Documentation should support the severity and chronicity of GERD symptoms and the failure of conservative treatment options.
The surgeon is responsible for the entire procedure, from pre-operative planning and patient assessment to the intra-operative steps and post-operative follow-up. Anesthesia is typically provided by an anesthesiologist or certified registered nurse anesthetist (CRNA).
In simple words: This surgery repairs a weakened valve between the esophagus and stomach, often causing heartburn.The surgeon makes small cuts in the belly, uses a camera and tiny tools to wrap part of the stomach around the esophagus to strengthen the valve.
Laparoscopic surgical esophagogastric fundoplasty involves wrapping the upper portion of the stomach around the lower esophagus to treat gastroesophageal reflux disease (GERD). The procedure is performed laparoscopically, utilizing small incisions, a camera, and specialized instruments.The surgeon insufflates the abdomen with gas to improve visualization, addresses any adhesions, and carefully positions the esophagus and stomach before performing the fundoplication (partial or complete wrap of the stomach around the esophagus).Hemostasis is ensured, and the incisions are closed in layers.
Example 1: A 45-year-old female patient with severe GERD refractory to medical management is scheduled for a laparoscopic Nissen fundoplication (43280). The patient has a history of hiatal hernia. The procedure is successful, and the patient experiences significant improvement in GERD symptoms., A 60-year-old male patient with a long history of GERD and recurrent esophagitis undergoes a laparoscopic Toupet fundoplication (43280).During the procedure, significant adhesions are encountered and meticulously lysed. The patient has an uncomplicated post-operative recovery., A 38-year-old patient with a history of prior abdominal surgery requiring lysis of adhesions presents for laparoscopic fundoplication (43280). The surgeon notes significant scarring and performs meticulous dissection to prevent injury to adjacent structures. The fundoplication is successfully completed.
** Always refer to the most current CPT manual and payer guidelines for the most up-to-date information on coding and reimbursement.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: This information requires access to specific payer fee schedules and may vary based on geographic location and other factors.Consult a current fee schedule for RVU values and reimbursement rates.
- Global Days: The global period for this procedure will vary depending on the payer and may include pre-operative and post-operative care.Check with the specific payer for details.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier for this procedure is dependent upon the specific circumstances and should be determined in accordance with the payer's guidelines.
- Fee Schedule: Historical fee schedule data is not available through this source. Consult a historical fee schedule database for information on past reimbursement rates.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department