General Surgery Coding Alert

Question: We had a case where the surgeon had to “redo” an old fundoplication while performing a laparoscopic hiatal hernia repair with placement of Sirgisis mesh. How should we code this, and can we separately report the fundoplication? 

Codify Subscriber

Answer: You should report the surgeon’s work using 43282 (Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh).

You can see that the code definition states, “includes fundoplasty, when performed,” so you should not separately bill for the fundoplication. The procedure is included in the 43282 service, whether it’s the initial fundoplication or a “redo.”

To ensure that you don’t mistakenly double dip on the fundoplication, CPT® adds this text note, “Do not report 43213, 43214, 43220, 43233, 43249, 43281, 43282 in conjunction with 43280, 43450, 43453, 49568.” You can see that the code you’re reporting, 43232, is bundled with the fundoplication code, 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]). 

Watch CCI: Not surprisingly, Medicare’s Correct Coding Initiative (CCI) edits bundle 43280 as a column 2 code for 43282. The edit pair is listed with a modifier indicator of “0,” meaning that you cannot bill the two codes together under any circumstance. That includes the circumstance that the surgeon is re-doing an old fundoplication.