2025 CPT code 43334
(Active) Effective Date: N/A Revision Date: N/A Surgery - Repair of hiatal hernia Surgical Procedures on the Digestive System Feed
Surgical repair of a paraesophageal hiatal hernia (including fundoplication) via thoracotomy, excluding neonates, without mesh or prosthesis.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 51 for multiple procedures, 22 for increased procedural services, 58 for staged procedures).Check payer specific rules.
Medical necessity is established by documentation of symptoms (e.g., chest pain, dysphagia, dyspnea) related to the paraesophageal hernia.Conservative management must be documented as insufficient.The surgical approach must be justified based on the patient's clinical presentation and anatomical findings.
Thoracic surgeon or general surgeon performs the procedure.Responsibilities include preoperative assessment, surgical technique, and postoperative care. Anesthesiologist provides anesthesia and monitoring.
- Surgical Procedures on the Digestive System
- Digestive System; Hiatal Hernia Repair; Thoracotomy Approach
In simple words: The doctor repairs a hiatal hernia (where part of the stomach pushes up into the chest) through a chest incision.This involves stitching the stomach to prevent it from slipping back up and repairing the opening in the diaphragm. No artificial materials are used.
This CPT code 43334 denotes the surgical repair of a paraesophageal hiatal hernia, encompassing fundoplication, performed through a thoracotomy incision.The procedure excludes neonatal patients and does not involve the implantation of mesh or other prosthetic materials. The surgical approach involves a chest incision, typically on the left side.Adhesions are removed, and the hernia and hiatus are visualized. The herniated portion of the stomach is accessed, separated from the hernia sac, and repositioned into the abdominal cavity.A bougie may be used to dilate the gastroesophageal junction, and sutures may narrow the hiatus. Fundoplication is then completed by suturing the gastric fundus around the gastroesophageal junction (partial or complete wrap).A chest tube is placed, and the incision is closed.
Example 1: A 65-year-old female presents with intermittent chest pain and dysphagia.Endoscopy reveals a large paraesophageal hernia.A thoracotomy is performed to repair the hernia with fundoplication, without mesh., A 72-year-old male experiences severe dyspnea and is diagnosed with a large incarcerated paraesophageal hernia.An emergency thoracotomy is performed for hernia repair with fundoplication.No mesh is used due to the emergency nature of the procedure., A 58-year-old female with a history of GERD presents with recurrent symptoms despite medical management.A thoracotomy and repair of a paraesophageal hiatal hernia are performed, including fundoplication, without mesh. Postoperative care includes pain management and dietary recommendations.
Preoperative imaging (chest x-ray, barium swallow, or CT scan), operative report detailing the surgical technique, pathology report (if applicable), and postoperative recovery notes including chest tube management.
** This code excludes the use of mesh or other prosthetic materials.The fundoplication component is included in the code. Always confirm payer-specific coverage policies and coding guidelines before billing.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: This information requires access to current payer-specific fee schedules and RVU data. RVUs vary significantly based on geographic location, payer, and other factors.
- Global Days: The global surgical period for this procedure is dependent on payer policies. Consult specific payer guidelines for details.
- Payment Status: Active
- Modifier TC rule: TC modifier may be used for the technical component of the procedure under specific circumstances. This is subject to payer guidelines.
- Fee Schedule: Fee schedule data requires access to historical payer-specific fee schedules and is subject to changes over time.
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center