2025 CPT code 43333
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Laparoscopic repair of a paraesophageal hiatal hernia, with fundoplication and mesh or prosthetic implantation.
Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual and payer-specific guidelines for details.
Medical necessity for paraesophageal hiatal hernia repair is typically established based on the presence of significant symptoms, such as recurrent heartburn, dysphagia, and chest pain, that do not respond to medical management.Imaging studies confirming the diagnosis and severity of the hernia are crucial.
The surgeon is responsible for all aspects of the surgical procedure, including pre-operative assessment, surgical technique, post-operative care, and follow up.Anesthesiology and potentially other sub-specialties may also be involved.
In simple words: The doctor repairs a hiatal hernia (a stomach bulge into the chest) through an abdominal incision.This involves putting the stomach back in place, tightening the opening in the diaphragm, and using mesh to reinforce the repair.A special stitch, called a fundoplication, is also used to prevent the hernia from coming back.
This CPT code encompasses the surgical repair of a paraesophageal hiatal hernia via laparotomy, including fundoplication and the implantation of mesh or another prosthesis.The procedure involves an abdominal incision, mobilization of the liver to visualize the hiatus, removal of adhesions, repositioning of the herniated stomach portion, and narrowing of the diaphragmatic esophageal hiatus.Fundoplication, the wrapping of the gastric fundus around the esophagus, is performed to prevent recurrence.The use of a bougie for dilation may be included. This code excludes neonatal cases (use 39503 for neonatal diaphragmatic hernia repair).
Example 1: A 55-year-old male patient presents with symptoms of heartburn, dysphagia (difficulty swallowing), and chest pain.Endoscopy reveals a large paraesophageal hiatal hernia.The patient undergoes laparoscopic repair with fundoplication and mesh placement., A 70-year-old female patient with a history of gastroesophageal reflux disease (GERD) experiences severe symptoms and is diagnosed with a large paraesophageal hiatal hernia.She undergoes open surgical repair with fundoplication and synthetic mesh reinforcement., A 62-year-old male patient with a recurrent paraesophageal hiatal hernia after a previous repair attempts revisional laparoscopic surgery.Repair involves resection of the hernia sac, fundoplication, and reinforcement with a prosthetic mesh.
* Preoperative diagnosis including confirmation of paraesophageal hiatal hernia via imaging (e.g., endoscopy, barium swallow).* Detailed operative report including specific surgical techniques, mesh type and size, and fundoplication type.* Postoperative pathology report (if applicable).* Documentation supporting medical necessity for the procedure.* Appropriate consent forms.
** This code should not be used for neonatal cases.Always refer to the most up-to-date CPT coding guidelines and payer specific requirements for accurate billing.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires access to a specific fee schedule and may vary by payer and location.Consult the appropriate fee schedule for current RVU values and reimbursement rates.
- Global Days: The global period for this procedure will vary based on payer guidelines and the complexity of the case.Refer to individual payer guidelines for the specific global period.
- Payment Status: Active
- Modifier TC rule: The use of TC modifiers will depend on the specifics of the procedure and payer requirements.Refer to your specific payer's guidelines.
- Fee Schedule: Historical fee schedule data is not provided.Consult a reliable fee schedule database for historical fee information.
- Specialties:General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient