General Surgery Coding Alert

Question: We recently had a case in which our surgeon used mesh reinforcement with laparoscopic fundoplication — can we code the mesh?

Tennessee Subscriber

Answer: CPT^® does not contain a code to describe separate placement of mesh along with laparoscopic fundoplasty.

If the mesh placement was conducted for hernia repair along with fundoplasty, you can use 43282 (Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh). If the mesh placement was carried out only to reinforce the fundoplication, however you will have to report 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]).

Modifier may help: If placing the mesh added significant work to the procedure (at least 50 percent additional time or effort as compared to the average time/work for lap fundoplasty without mesh placement), you may append modifier 22 (Increased procedural services) to 43280.

Caution: Payers scrutinize modifier 22 claims carefully, and your documentation must legitimize its use. You may want to file the claim manually and attach a separate note explaining the unusual nature of the procedure, comparing the surgery to a “typical” lap fundoplasty and explicitly noting the additional time or effort required to place the mesh. You should specifically request increased payment.

For instance: You might write, “Due to the atypical nature of this procedure, increased risk and complexity, and the 25 percent increase in time necessary to place mesh reinforcement, we are requesting payment in the amount of 125 percent of the usual fee.”

In most cases, placement of mesh alone would probably not add enough additional work or time to report modifier 22, but in extraordinary cases it may.