CPT 39541 Repair of Recurrent Diaphragmatic Hernia Reimbursement | OpenPayer

Summary & Overview

CPT 39541: Repair of Recurrent Traumatic Diaphragmatic Hernia

CPT code 39541 denotes the surgical repair of a recurrent diaphragmatic hernia attributable to a chronic traumatic injury to the diaphragm and excludes neonatal hernia repair. This operative code is significant for hospitals and surgical practices that manage post-traumatic diaphragmatic injuries, affecting coding accuracy, case mix classification, and payer reimbursement pathways nationwide. Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical scenario and typical sites of service, an overview of payer coverage considerations, common modifiers used with the code, and context for billing and documentation priorities. The publication outlines national benchmark topics, relevant policy and coding guidance updates, and the clinical context needed to distinguish recurrent traumatic diaphragmatic hernia repair from other diaphragmatic procedures. Data not available in the input is identified where applicable, including associated taxonomies, ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 39541diaphragmatic hernia repairtraumatic diaphragmatic injurysurgical billingoperative codeinpatient surgeryoutpatient surgeryprocedural coding

Billing Code Overview

CPT code 39541 describes the surgical repair of a recurrent diaphragmatic hernia resulting from a chronic traumatic injury to the diaphragm. The code explicitly excludes repair of a neonatal hernia.

Service Type: Surgical repair of recurrent traumatic diaphragmatic hernia

Typical Site of Service: Inpatient or outpatient surgical setting, commonly performed in an operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who previously sustained a penetrating or blunt thoracoabdominal trauma and now presents months to years later with symptoms from a recurrent traumatic diaphragmatic hernia. The patient often reports progressive shortness of breath, chest pain or gastrointestinal symptoms such as early satiety, nausea, or intermittent obstruction. Diagnostic evaluation includes chest radiograph and contrast-enhanced CT of the chest and abdomen confirming herniation of abdominal viscera into the thoracic cavity and demonstrating defect recurrence. Pulmonary and cardiac clearance is obtained preoperatively; anesthesia evaluation and informed consent address risks of thoracic surgery and potential need for chest tube placement. The operative plan is an open or thoracoscopic approach for surgical repair of the recurrent diaphragmatic defect with reduction of herniated contents, resection of nonviable tissue if present, and primary repair or prosthetic mesh reinforcement. Postoperative care includes analgesia, respiratory support as needed, chest tube management, and imaging to confirm repair integrity before discharge. Typical sites of service are inpatient hospital operating room or ambulatory surgical center for selected stable patients; ICU or step-down care may be needed for high-risk patients.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Use when no specific modifier applies to the claim

CPT 39503: Congenital Diaphragmatic Hernia Repair, Newborn

CPT-39545-DIAPHRAGMATIC-PLICATION-REPAIR-ELEVATED-DIAPHRAGM

CPT 39545: Diaphragmatic Plication for Elevated Diaphragm

CPT-39540-TRAUMATIC-DIAPHRAGMATIC-HERNIA-REPAIR

CPT 39540: Surgical Repair of Traumatic Diaphragmatic Hernia

CPT-39501-DIAPHRAGM-REPAIR-TRAUMATIC-TEAR

CPT 39501: Repair of Diaphragmatic Tear from Trauma

CPT-39560-DIAPHRAGM-RESECTION-AND-PRIMARY-REPAIR

CPT 39560: Diaphragm Resection and Primary Repair

CPT-39561-DIAPHRAGM-RESECTION-AND-REPAIR

CPT 39561: Diaphragm Resection with Involved Repair

Taxonomy Code	Specialty	Notes
207H00000X	Thoracic Surgery	Thoracic surgeons commonly perform repairs of recurrent traumatic diaphragmatic hernias, especially via thoracotomy or thoracoscopic approaches
207L00000X	General Surgery	General surgeons perform diaphragmatic hernia repairs, particularly via abdominal approach and mesh reinforcement
2080P0106X	Pediatric Surgery	Pediatric surgeons are involved when older infants or children present with traumatic diaphragmatic hernia recurrence (neonatal excluded)
208800000X	Critical Care Medicine	Critical care physicians manage perioperative ICU care for high-risk patients after complex repairs
2084P0800X	Anesthesiology	Anesthesiologists provide perioperative anesthesia care and airway management for thoracic surgical repair

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32663`	Thoracotomy, surgical; with repair of diaphragmatic disruption	Alternative thoracic procedure code used when primary approach is thoracotomy for diaphragm repair; may be used in conjunction or as an alternative depending on operative technique
`43280`	Laparoscopy, surgical, repair, paraesophageal hiatal hernia, with or without fundoplication	May be performed when abdominal approach is chosen for reduction and repair of diaphragmatic defect in select cases (technique-dependent)
`49560`	Repair initial incisional or ventral hernia; reducible	Not specific to diaphragm but may be reported when concurrent abdominal wall hernia repairs are performed during the same operative session
`32551`	Tube thoracostomy, includes connection to water seal, when performed	Often performed intraoperatively or postoperatively for chest drainage after reduction of intrathoracic viscera and pleural entry
`44204`	Laparoscopy, surgical; enterolysis (separate procedure)	May be performed for adhesiolysis if intra-abdominal adhesions complicate reduction of herniated contents prior to diaphragmatic repair

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