AHA Coding Clinic® for HCPCS - 2017 Issue 2; Ask the Editor

Laparopscpic redo hiatal hernia repair

A patient with a history of a hiatal hernia repair and Nissen fundoplication in 2013 was seen at our facility and found to have a recurrent hiatal hernia with dysphagia and reflux, twisting of the distal esophagus and an extremely loose fundoplication. In order to get good visualization of the hiatus as well as to get a better fundoplication, the previous fundoplication had to be taken down. A GIA stapler was inserted and fired across the previous fundoplication as close to the suture line as possible. Once the crural stitch had been placed, a 10 x 10 sheet of biologic mesh was placed. Fundoplication was then performed using 0 Silk and Ti-Knot. The plication appeared loose and the clamp passed through it easily. Posterior wrap was then secured to the crura with a single stitch.  Our Encoder directs us to Unlisted CPT code 43289 for a revision and/or takedown. Some of our coders agree with this because the procedure involves more than the description of 43282. Others feel 43282 is appropriate.  What is the CPT code(s) to use for a Laparoscopic Re-do hiatal hernia repair with patch reinforcement and Fundoplication? ...

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