Summary & Overview
CPT 43328: Thoracic Fundoplasty (Open Fundoplication)
CPT code 43328 represents a thoracic approach fundoplasty (partial or complete fundoplication) performed through a chest incision to wrap the stomach around the lower esophagus. This surgical code captures open thoracic fundoplication procedures used to address gastroesophageal reflux and related esophageal disorders. Nationally, this code is relevant for hospital and ambulatory surgery center billing, surgical quality reporting, and payer coverage policies for antireflux operations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for thoracic fundoplication, common billing patterns for open chest approaches, and the types of benchmarks and policy topics typically examined for this service. The publication summarizes typical sites of service and service type, outlines commonly reported modifiers provided in the input, and highlights areas where payer policy language and reimbursement rules often influence coding and claims adjudication. Where specific benchmark or taxonomy data are not present, the report notes that data are not available in the input and focuses on available national-level implications for coding and billing workflows.
Billing Code Overview
CPT code 43328 describes a partial or complete fundoplasty performed through a thoracic (chest) incision, in which the provider wraps the upper portion of the stomach around the lower esophagus. This procedure is a surgical intervention to reinforce the lower esophageal sphincter and reduce gastroesophageal reflux symptoms.
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Service type: Surgical — open thoracic fundoplication
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Typical site of service: Inpatient or outpatient operating room in a hospital or ambulatory surgery center, via a chest (thoracic) approach
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic gastroesophageal reflux disease (GERD) or a hiatal hernia refractory to optimal medical therapy, presenting with chronic heartburn, regurgitation, or aspiration. Preoperative evaluation includes upper endoscopy, esophageal pH monitoring, esophageal manometry, and chest/abdominal imaging to assess anatomy and motility. The patient is optimized medically and cleared for general anesthesia. The surgeon performs a partial or complete fundoplasty via a transthoracic approach through a chest incision to reinforce the lower esophageal sphincter and reduce reflux; intraoperative steps include mobilization of the gastric fundus, creation of a 270–360° wrap (partial or complete), repair of a concurrent hiatal defect if present, and intraoperative testing of wrap tension. Postoperative workflow includes recovery in PACU, pain control, early ambulation, diet advancement from liquids to soft diet, and outpatient follow-up with activity and dietary restrictions. Typical site of service is an inpatient or ambulatory surgical hospital setting with thoracic surgery capabilities; the service type is a thoracic surgical procedure performed through a chest incision.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician billing for the initial service | Use when the performing surgeon bills for the primary procedure as usual. |