2025 CPT code 43325
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagus Procedures Digestive System Feed
Esophagogastric fundoplasty with fundic patch (Thal-Nissen procedure).
Modifiers may be applied depending on the circumstances of the surgery.For example, modifier 51 (Multiple Procedures) may be applicable if additional procedures are performed during the same operative session.
Medical necessity for 43325 is established when a patient has failed conservative management for GERD or esophageal strictures, and the condition significantly impacts their quality of life and requires surgical intervention.Documentation must support the need for surgical repair based on clinical presentation and prior treatment failures.
The surgeon is responsible for the pre-operative assessment, the surgical procedure itself, including incision, exploration, mobilization of the fundus, fundoplication with patch placement, bougie dilation (if needed), hemostasis and wound closure, as well as post-operative monitoring and follow-up care.
In simple words: The doctor repairs the lower part of the esophagus (the tube connecting the mouth and stomach) using a piece of stomach tissue to widen and strengthen it.This helps prevent stomach acid from flowing back up into the esophagus.
This procedure involves repairing the distal esophagus using a fundic patch.The surgeon makes an incision in the upper abdomen, explores the stomach and esophagus, and mobilizes the gastric fundus. A portion of the fundus is then wrapped around and secured to the base of the esophagus to reinforce the gastroesophageal junction. A bougie may be used to dilate the junction.This technique is often used to treat esophageal strictures or gastroesophageal reflux disease (GERD).
Example 1: A patient presents with severe GERD and a history of esophageal strictures unresponsive to conservative treatment.A Thal-Nissen fundoplication with fundic patch is performed to repair the esophageal stricture and provide anti-reflux protection., A patient with achalasia (failure of the lower esophageal sphincter to relax) undergoes a Thal-Nissen procedure with a fundic patch to widen the narrowed esophageal opening and improve esophageal motility., A patient with recurrent GERD after a previous fundoplication procedure undergoes a revision surgery using a Thal-Nissen technique with a fundic patch to correct the inadequacies of the previous surgery.
* Preoperative evaluation including history and physical examination, endoscopic findings (e.g., endoscopy report demonstrating stricture or GERD), and any imaging studies.* Operative report detailing the surgical technique, including the use of a fundic patch, bougie dilation (if performed), and hemostasis.* Postoperative progress notes documenting the patient's recovery and any complications.* Pathology reports (if applicable).
** This procedure is considered a major surgical procedure and requires appropriate anesthesia and surgical support staff.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires access to a specific year's relative value units (RVUs) and conversion factors from the CMS.RVUs vary by location and payer.
- Global Days: The global period for this procedure would need to be determined based on the specific payer's guidelines and may vary.
- Payment Status: Active
- Modifier TC rule: The application of a TC modifier depends on whether the procedure is performed by a surgeon and an assistant surgeon. In such a case, the TC modifier may apply to the assistant surgeon's services.
- Fee Schedule: Historical fee schedule data is not available in this response.This data can be accessed through various commercial billing and coding software.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center