Wiki Hiatal Hernia repair and LINX procedure

[AT2728]

Any guidance would be GREATLY appreciated! We have surgeons who occasionally perform HH repairs along with LINX placement. We had been instructed by their main office to bill for the 43280/43281 HH repair accordingly and that the LINX 42384 procedure would be inclusive. Which I totally understand. Our surgeons will never perform the LINX as a stand alone, those patients are referred. However, the facility 3M coder has provided the following information, citing the AMA CPT assistant from April 2019:

Q. What is the appropriate CPT code to report the placement of an esophageal sphincter augmentation device when a HH repair is also performed?

A. Report code 43284, lap, surgical, esophageal etc.... for the entirety of the work described. When CPT code 43284 was created, the procedure was described for use only in patients with small hiatal hernias less than 3 cm because the literature supported the use of the device only in these circumstances. As a result, the work of crurosplasty was included in the code descriptor.

I've spent hours trying to locate additional information. It does appear that a majority of other offices are also billing the HH repair codes and not 43284. We now have conflicting opinions and I'm in the middle of this struggle between the facility and the surgeons.

 

[jlgwalt64]

I, too, have spent hours searching for additional info. The only other information I've been able to find on this subject agrees with the CPT Assistant, except that it does not state the HH had to be within a certain size, so basically including any and all hiatal hernia repairs. These AHA Coding Clinics and CPT Assistants all support code 43284 when billing the LINX procedure in addition to a hiatal hernia repair:
AHA Coding Clinic 4/1/2017
AHA Coding Clinic 7/1/2018
AHA Coding Clinic 4/1/2019
CPT Assistant 9/1/2018 - this one specifically states that code 43281 should not be reported separately.
CPT Assistant 4/1/2019 - only one to specify inclusion of size of HH less than 3cm.
I cannot find anything else and it is very frustrating when we're supposed to trust, and/or depend on, these resources for guidance and this directive just makes no sense whatsoever, we all know it, but we're caught in the middle.
Good Luck!