General Surgery Coding Alert

Question: The surgeon performed a redo laparoscopic Nissen, but the original surgery was more than 12 years ago. How should I code for this?


Colorado Subscriber
Answer: The -redo- aspect of the service won't affect your primary coding. You should report the procedure using the standard code for a laparoscopic Nissen procedure--43280 (Laparoscopy, surgical, esophagogastric fundoplasty [e.g., Nissen, Toupet procedures]).

Because this procedure is a redo, however, the surgeon may have encountered considerably more difficulty than during a first-time Nissen procedure. For example, the surgeon may encounter excessive scarring or adhesions, or he may have to unwrap and rewrap a portion of the previous fundoplasty. These complications could add time and effort to the procedure.

If the surgeon documents complications that considerably extend the time or effort required to complete the procedure, you may choose to append modifier 22 (Unusual procedural services) to 43280 and request additional compensation. Be sure to request specifically the additional compensation, and include a cover letter explaining why the surgery was unusual, along with a complete operative report.