2025 CPT code 43281
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Laparoscopic repair of paraesophageal hernia, including fundoplasty, without mesh implantation.
Modifiers can be applied to indicate specific circumstances related to the procedure.Common modifiers include 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), and others as appropriate.
Medical necessity for this procedure is established by documenting the patient's symptoms related to the paraesophageal hernia (e.g., dysphagia, chest pain, shortness of breath, early satiety) and correlating them with imaging findings. The documentation should demonstrate the severity of symptoms impacting the patient's quality of life and justify the need for surgical intervention.
The surgeon is responsible for pre-operative assessment, obtaining informed consent, performing the laparoscopic repair, post-operative care, and managing any complications. This includes reducing the hernia, repairing the diaphragm, performing a fundoplasty if indicated, and ensuring hemostasis.
In simple words: The surgeon makes small incisions in the abdomen and inserts a camera and instruments to repair a hernia where the stomach is pushing through the diaphragm next to the esophagus. They put the stomach back in place, close the opening in the diaphragm, and may wrap part of the stomach around the esophagus to prevent reflux. This is all done using small incisions and a camera, not a large open cut.
This code describes a laparoscopic procedure to repair a paraesophageal hernia, a condition where part of the stomach protrudes through the diaphragm alongside the esophagus. The procedure involves reducing the herniated stomach back into the abdomen, closing the diaphragmatic defect, and often includes a fundoplasty to reinforce the lower esophageal sphincter. Mesh is not used in this specific code.
Example 1: A 55-year-old patient presents with dysphagia and chest pain. Imaging reveals a paraesophageal hernia. The surgeon performs a laparoscopic repair, including a Toupet fundoplication, without mesh, to address the hernia and prevent reflux., A 70-year-old patient with an incidentally discovered paraesophageal hernia develops worsening symptoms of early satiety and abdominal discomfort.Laparoscopic repair of the hernia is performed using a Nissen fundoplication, without mesh., A 40-year-old patient experiencing shortness of breath and occasional chest pain is diagnosed with a paraesophageal hernia.A laparoscopic paraesophageal hernia repair without fundoplasty or mesh is performed.
Documentation should include operative report detailing the size and location of the hernia, type of fundoplasty (if performed), confirmation of no mesh use, intraoperative findings, and any complications. Pre- and post-operative diagnoses, imaging reports supporting the diagnosis, and documentation of medical necessity should also be included.
- Revenue Code: P8I (ENDOSCOPY - OTHER)
- Payment Status: Active
- Specialties:General Surgery, Thoracic Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital