CPT 39545 Diaphragmatic Plication Reimbursement | OpenPayer

Summary & Overview

CPT 39545: Diaphragmatic Plication for Elevated Diaphragm

CPT code 39545 covers surgical plication of the diaphragm to correct extreme elevation from abdominal organ protrusion, performed via transthoracic or transabdominal approaches. This is a specialized thoracic or general surgical procedure used to restore diaphragmatic position and function when severe elevation or paralysis compromises respiration or organ position. Nationally, the procedure is clinically significant for pulmonary and gastrointestinal outcomes in affected patients and is typically performed in hospital operating rooms under general anesthesia.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of how the code maps to clinical practice, where the service is typically delivered, and which major payers commonly cover the service.

Readers will find benchmarks and policy context relevant to billing and authorization for diaphragmatic plication, concise clinical context for appropriate use, and identification of common site-of-service considerations. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 39545diaphragmatic plicationthoracic surgerytransabdominal approachsurgical repairinpatient surgeryrespiratory dysfunction

Billing Code Overview

CPT code 39545 describes surgical repair of an extreme elevation of the diaphragm caused by abdominal organ protrusion. The procedure involves arranging the connective tissue of the diaphragm in an overlapping manner to reduce and secure the elevated hemidiaphragm; the diaphragm may be paralyzed. The provider may perform this repair via a transthoracic approach through the thorax or a transabdominal approach through the abdomen.

Service type: Surgical repair of diaphragmatic elevation (open or transthoracic/transabdominal diaphragmatic plication)
Typical site of service: Inpatient operating room or hospital-based surgical suite

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with progressive dyspnea, orthopnea, and chest imaging showing extreme elevation of the left hemidiaphragm with abdominal viscera partially protruding into the thoracic cavity and impaired diaphragmatic excursion. The surgical team elects to perform a diaphragmatic plication to restore normal diaphragmatic contour and reduce cardiopulmonary compromise. Preoperative workflow includes history and physical, pulmonary function testing, chest radiography and CT chest to define anatomy, anesthesiology evaluation, and informed consent. The procedure is performed in an operating room under general anesthesia with single-lung ventilation if a transthoracic approach is used, or via a transabdominal approach when indicated. Intraoperative steps include exposure of the elevated diaphragm, identification of the phrenic nerve and any areas of paralysis, and overlapping suturing of diaphragmatic connective tissue to plicate and reduce the dome. Postoperative workflow includes chest tube management if placed, pain control, pulmonary hygiene, chest radiograph to confirm position and lung expansion, and follow-up pulmonary function testing and clinic visits to assess symptomatic improvement.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than typical (extensive adhesiolysis, unexpected complexity).

CPT 39501: Repair of Diaphragmatic Tear from Trauma

CPT-39503-CONGENITAL-DIAPHRAGMATIC-HERNIA-REPAIR-NEWBORN

CPT 39503: Congenital Diaphragmatic Hernia Repair, Newborn

CPT-39541-RECURRENT-TRAUMATIC-DIAPHRAGMATIC-HERNIA-REPAIR

CPT 39541: Repair of Recurrent Traumatic Diaphragmatic Hernia

CPT-39540-TRAUMATIC-DIAPHRAGMATIC-HERNIA-REPAIR

CPT 39540: Surgical Repair of Traumatic Diaphragmatic Hernia

CPT-39561-DIAPHRAGM-RESECTION-AND-REPAIR

CPT 39561: Diaphragm Resection with Involved Repair

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

CPT 39560: Diaphragm Resection and Primary Repair

Taxonomy Code	Specialty	Notes
`2080S0010X`	Thoracic Surgery	Thoracic surgeons commonly perform transthoracic plication and manage intra-thoracic adhesions.
`207L00000X`	General Surgery	General surgeons perform transabdominal approaches and manage concomitant abdominal pathology.
`208600000X`	Pediatric Surgery	Pediatric surgeons perform diaphragmatic plication in neonates and infants with congenital or paralytic diaphragms.
`2084P0800X`	Cardiothoracic Surgery	Cardiothoracic surgeons perform complex diaphragmatic procedures, often with concurrent cardiac procedures.
`207K00000X`	Minimally Invasive Surgery	MIS specialists perform video-assisted thoracoscopic or laparoscopic plication approaches.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K44.9`	Unspecified diaphragmatic hernia	Diaphragmatic hernias presenting with abdominal viscera protrusion and diaphragmatic elevation may require plication.
`K44.2`	Diaphragmatic hernia with obstruction, without gangrene	Hernias causing respiratory compromise where plication and repair reduce symptoms.
`J98.4`	Other disorders of diaphragm	Includes diaphragmatic elevation or paralysis symptoms leading to plication.
`G52.6`	Phrenic nerve disorders	Phrenic nerve injury or paralysis causing diaphragmatic paralysis and indication for plication.
`Q79.0`	Congenital diaphragmatic hernia	Neonatal or pediatric indication for surgical repair and plication.
`J96.9`	Respiratory failure, unspecified	Severe respiratory compromise secondary to diaphragmatic dysfunction prompting surgical intervention.
`S37.8`	Injury of other intrathoracic organs (includes traumatic diaphragm injury)	Traumatic diaphragmatic injury with elevation or herniation that may be repaired with plication.
`R06.6`	Respiratory insufficiency, unspecified	Symptomatic respiratory insufficiency attributable to diaphragmatic elevation indicating plication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`39200`	Repair of traumatic diaphragmatic hernia; without thoracotomy or laparotomy, simple	Alternative or adjunct when smaller diaphragmatic defects are repaired without full plication.
`39330`	Repair of congenital diaphragmatic hernia; infant and/or child, thoracic approach (repair of congenital diaphragmatic hernia)	Performed in pediatric patients for congenital defects that may require plication or reconstruction.
`32663`	Thoracotomy for repair of traumatic diaphragmatic hernia with prosthetic repair	May be performed when diaphragmatic defect is large and requires prosthetic reinforcement in addition to plication.
`43280`	Laparoscopic repair, paraesophageal hiatal hernia, with or without gastropexy; without prosthetic material	Transabdominal laparoscopic approaches for diaphragmatic elevation due to large hiatal defects may be performed in conjunction.
`35860`	Thoracoscopy, surgical; with pleurectomy, decortication and/or partial lobectomy (major thoracic procedures)	Performed when concomitant intrathoracic procedures are required during transthoracic plication.

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