Gastroenterology Coding Alert

Question: Our patient was receiving treatment for GERD but saw no improvement from medication. He decided to proceed with an esophageal sphincter augmentation device procedure because it was less invasive than a traditional laparoscopic fundoplasty. The patient displayed esophagitis resulting from a hiatal hernia, so the surgeon repaired the hernia with a cruroplasty during the placement of the magnetic band. Which codes apply to this procedure?

Codify Subscriber

Answer: In this situation, you'll report the following codes:

• 43284 - Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed) for the magnetic band placement.
• K21.0 - Gastro-esophageal reflux disease with esophagitis
• K44.9 - Diaphragmatic herniawithout obstruction or gangrene (includes esophageal hiatus hernia)

You should not report a separate additional cruroplasty procedure, because it's included in the descriptor for the sphincter augmentation. However, some payers do not cover the magnetic band implantation as an anti-reflux procedure, but do cover the hiatal hernia repair; those practices would report 43280-43283 series codes without the 43284 codes, since CPT^® instructions indicate that 43284 should not be reported together with 43280-43283 series codes. Thus, it is important to know your common carriers' coverage policies.