2025 CPT code 43327
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Partial or complete esophagogastric fundoplasty performed through an abdominal incision.
Modifiers are applicable. Common modifiers used with 43327 include 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), and others as appropriate.
Medical necessity for 43327 is established by documenting the patient's symptoms, failed conservative management of GERD or hiatal hernia, and the severity of the condition impacting their quality of life.Preoperative studies, such as esophagogastroduodenoscopy (EGD) and esophageal manometry, may be necessary to assess the severity and guide surgical intervention.
The surgeon is responsible for the entire procedure, including prepping the patient, making the incision, mobilizing the liver, removing adhesions, repositioning the stomach and gastroesophageal junction if necessary, dilating the esophagus with a bougie if required, wrapping the fundus of the stomach around the esophagus, achieving hemostasis, and closing the incision.
In simple words: The surgeon makes an incision in the belly and wraps the upper part of the stomach around the lower end of the esophagus to create a tighter valve. This helps prevent stomach acid from backing up into the esophagus.
The physician performs a partial or complete fundoplasty, which involves wrapping the upper part of the stomach (fundus) around the lower esophagus, through an abdominal incision (laparotomy).The procedure reinforces the lower esophageal sphincter to address gastroesophageal reflux.The surgeon mobilizes the liver, visualizes the esophageal hiatus, removes any adhesions, and may reposition the stomach and gastroesophageal junction. An esophageal bougie may be used to dilate the passage. The fundus of the stomach is then sutured around the esophagus, either partially or completely. Hemostasis is achieved, and the incision is closed.
Example 1: A patient with chronic gastroesophageal reflux disease (GERD) unresponsive to medical management undergoes an esophagogastric fundoplasty (43327) to reinforce the lower esophageal sphincter., A patient with a large hiatal hernia causing GERD symptoms undergoes esophagogastric fundoplasty (43327) through a laparotomy to repair the hernia and prevent further reflux., A patient with recurrent vomiting and aspiration due to a weak lower esophageal sphincter undergoes 43327 to strengthen the valve and reduce the risk of complications.
Documentation should include operative report details of the fundoplasty (partial or complete), the surgical approach (laparotomy), any associated procedures performed (e.g., hernia repair, lysis of adhesions), the use of a bougie if applicable, and any intraoperative or postoperative complications encountered.
- Revenue Code: P1G - Major Procedure - Other
- Payment Status: Active
- Specialties:General surgery, thoracic surgery, and sometimes gastroenterology (for diagnostic evaluation and medical management of GERD prior to surgical referral).
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center