2025 CPT code 43332
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Repair of paraesophageal hiatal hernia (including fundoplication) via laparotomy, except neonatal; without implantation of mesh or other prosthesis.
Modifiers may be applicable in specific situations, such as significant additional procedures (modifier 22) or distinct procedural services (modifier 59).
The medical necessity for 43332 is established by documenting the patient's symptomatic paraesophageal hiatal hernia, such as persistent heartburn, regurgitation, chest pain, difficulty swallowing, or other related symptoms.Evidence of failed conservative management, like dietary changes or medication, further strengthens the case for surgical intervention.The specific choice of a laparotomy over a minimally invasive approach should also be justified, perhaps due to prior abdominal surgeries, anatomical considerations, or surgeon preference.
The surgeon performs the entire procedure, from the initial incision and mobilization of the liver to the repositioning of the stomach, fundoplication, closure of the diaphragmatic hiatus, and final closure of the abdominal incision.
In simple words: The surgeon makes an incision in the abdomen to access and repair a paraesophageal hiatal hernia, which is when part of the stomach pushes up through the diaphragm next to the esophagus. The operation also involves wrapping the upper part of the stomach around the esophagus to prevent reflux. No mesh or other artificial materials are used in this specific procedure, and it's not performed on newborns.
Through an abdominal incision (laparotomy), the surgeon repairs a paraesophageal hiatal hernia, a condition where the stomach protrudes through the diaphragm alongside the esophagus. This procedure involves a fundoplication, which wraps the top of the stomach around the lower esophagus to prevent acid reflux.It is important to note that this code specifically excludes the use of mesh or other prosthetic materials for reinforcement and is not applicable to newborns.
Example 1: A 55-year-old patient experiences persistent heartburn, chest pain, and difficulty swallowing due to a paraesophageal hiatal hernia.Diagnostic imaging confirms the diagnosis, and the patient undergoes a laparotomy with fundoplication to correct the hernia and address the reflux symptoms., A 30-year-old patient presents with intermittent episodes of abdominal pain, bloating, and vomiting.After a thorough evaluation, a paraesophageal hiatal hernia is diagnosed. Due to the intermittent nature of the symptoms and the risk of future complications, the patient elects to undergo laparoscopic paraesophageal hernia repair without mesh, as the hernia size is suitable for a minimally invasive approach., A patient with a history of a paraesophageal hernia repair using mesh experiences recurrent hernia. Revision surgery is performed using 43332 via laparotomy and fundoplication, avoiding mesh due to the previous complications.
Operative report detailing the size and location of the hernia, the type of fundoplication performed, any intraoperative complications encountered, and confirmation of the absence of mesh or prosthesis use. Pre-operative diagnostic imaging reports, such as a barium swallow or upper endoscopy, should be included. Medical history documenting the patient's symptoms, prior treatments, and overall health status is essential.
- Payment Status: Active
- Specialties:General Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital