2025 CPT code 43335
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Repair of a paraesophageal hiatal hernia (including fundoplication) via thoracotomy, except neonatal; with implantation of mesh or other prosthesis.
Modifiers may be applicable depending on the specific circumstances of the procedure. For example, modifier 51 (multiple procedures) could be used if other procedures were performed during the same operative session.
Medical necessity is established by the presence of significant symptoms attributable to the paraesophageal hiatal hernia, such as dysphagia, recurrent vomiting, chest pain, or shortness of breath.The procedure is considered medically necessary to relieve these symptoms and prevent complications.
The surgeon performs a thoracotomy, addresses any adhesions, visualizes the hernia and hiatus, reduces the herniated stomach into the abdomen, may dilate the gastroesophageal junction with a bougie, repairs the hiatus with sutures, implants mesh or prosthesis for reinforcement, performs fundoplication, controls bleeding, places a chest tube, and closes the incision.
In simple words: The doctor repairs a hiatal hernia through a chest incision. This type of hernia happens when part of the stomach pushes up into the chest cavity next to the esophagus. The repair includes wrapping part of the stomach around the esophagus to prevent it from happening again and using a mesh or similar material to strengthen the repair. This code is not used for babies.
This CPT code describes the surgical repair of a paraesophageal hiatal hernia, which involves a chest incision (thoracotomy).The procedure includes fundoplication (wrapping a portion of the stomach around the lower esophagus) and the implantation of a mesh or other prosthetic material to reinforce the repair. This code is not applicable to newborns; for neonatal diaphragmatic hernia repair, use code 39503.
Example 1: A 55-year-old male presents with symptoms of dysphagia (difficulty swallowing) and heartburn.Endoscopy confirms a large paraesophageal hiatal hernia.The surgeon performs a thoracotomy, repairs the hernia with mesh, and completes a fundoplication., A 70-year-old female with a history of gastroesophageal reflux disease (GERD) experiences recurrent vomiting and chest pain. Imaging reveals a paraesophageal hiatal hernia with significant stomach displacement. The surgeon performs a thoracotomy, repairs the hernia using a synthetic prosthesis, and performs a partial fundoplication., A 60-year-old male presents with chronic chest pain and shortness of breath. Investigations show a large, complicated paraesophageal hiatal hernia with severe inflammation and adhesion formation. The surgeon performs an extensive thoracotomy, meticulously dissects the adhesions, repairs the hernia with a large mesh, and performs a complete fundoplication. A chest tube is inserted for drainage.
Preoperative imaging (e.g., barium swallow, endoscopy, CT scan) showing the hernia; operative report detailing the surgical technique, type of mesh used, and fundoplication type; postoperative imaging to confirm the repair; pathology report if tissue is removed.
** Always confirm the appropriate code based on the specifics of the procedure. Review codes 43332-43337 for similar procedures.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center