General Surgery Coding Alert

Question: In accordance with the new laparoscopic hernia codes listed in General Surgery Coding Alert; does 49652 incorporate the hiatal hernia repair? I was told that epigastric hernia repair is the same, but our surgeon does not agree. What is the correct code to use for laparoscopic repair of hiatal hernia?

Texas Subscriber

Answer: CPT does not contain a specific code to describe laparoscopic hiatal hernia repair, even with the addition of the new laparoscopic hernia repair codes this year. Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).

If the surgeon performed an open hiatal hernia repair, however, you would select 39520 (Repair, diaphragmatic hernia [esophageal hiatal]; transthoracic) for a transthoracic approach, or choose between 39530 (&combined, thoracoabdominal) and 39531 (& combined, thoracoabdominal, with dilation of stricture [with or without gastroplasty]), as appropriate.

Clinical rationale: Your surgeon is correct that an epigastric hernia is not the same as a hiatal hernia. An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where the esophagus transits the chest cavity to the abdominal cavity.