Summary & Overview
CPT 43332: Paraesophageal Hiatal Hernia Repair with Fundoplication
CPT code 43332 represents an open abdominal repair of a paraesophageal hiatal hernia with fundoplication and without prosthetic implantation. This operative code is used for adult patients undergoing surgical reduction of a stomach that has migrated adjacent to the esophagus and concurrent anti-reflux reconstruction. Nationally, procedures for hiatal hernia and anti-reflux surgery are significant due to surgical volume, perioperative resource use, and implications for hospital surgical quality measures.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review covers how CPT code 43332 is billed across settings, typical sites of service (hospital operating room and ambulatory surgery centers), and common clinical contexts for paraesophageal hernia repair.
Readers will find a concise clinical and billing overview, typical service lines and sites of care, and discussion of common modifiers encountered with surgical services. The content highlights national relevance for surgical services, payer coverage patterns, and practical coding context for revenue cycle and clinical teams. Data not available in the input are clearly noted where applicable.
Billing Code Overview
CPT code 43332 describes a surgical repair of a paraesophageal hiatal hernia performed through an abdominal incision that includes a fundoplication. The procedure involves reducing the stomach and repairing the diaphragmatic hiatus without implantation of mesh or other prosthetic material. This code is not appropriate for a newborn.
Service type: Inpatient or outpatient surgical procedure, open abdominal anti-reflux and hernia repair
Typical site of service: Hospital operating room or ambulatory surgery center
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult (often middle-aged to elderly) presenting with symptomatic paraesophageal hiatal hernia causing reflux, dysphagia, chest or upper abdominal pain, or recurrent aspiration. After gastroenterology evaluation including upper endoscopy and imaging (barium swallow, CT), and failure of optimized medical therapy for gastroesophageal reflux disease (GERD) or symptom progression, the surgeon schedules an open abdominal repair with fundoplication via an abdominal incision using CPT 43332. Preoperative workflow includes pre-op assessment, anesthesia evaluation, informed consent discussing risks and benefits of open repair without prosthetic mesh, baseline labs, and imaging review. Intraoperative workflow involves abdominal access, reduction of the herniated stomach, crural repair, and performance of a fundoplication (typically Nissen or partial depending on anatomy). No mesh or prosthetic is implanted. Postoperative care includes recovery in PACU, pain control, advancement of diet from clear liquids, and discharge planning with activity restrictions and outpatient follow-up for wound check and swallow function as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this open paraesophageal hernia repair with fundoplication is the principal service of the operative session |
22 | Increased procedural services | When substantially greater work is documented due to complexity (extensive adhesiolysis, emergent anatomic distortion) |
52 | Reduced services | When the procedure is partially reduced or not completed as documented (aborted repair) |
53 | Discontinued procedure | When the procedure is terminated due to extenuating circumstances or life-threatening situation |
62 | Two surgeons | When two surgeons with distinct surgical roles actively participate throughout the procedure |
66 | Surgical team | When a surgical team approach is used with documented roles |
78 | Unplanned return to the OR by same surgeon | For an unplanned return to the OR for a related procedure during the global period |
79 | Unrelated procedure or service by the same physician during the postoperative period | For unrelated procedures performed during the global period |
AS | Ambulatory surgical center facility | When the service is furnished in an ambulatory surgical center (if applicable) |
50 | Bilateral procedure | If a bilateral modifier ever applied (not typical for hiatal hernia repair) — used only when appropriate |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208000000X | General Surgery | Most common specialty performing open paraesophageal hernia repair with fundoplication |
| 208600000X | Thoracic Surgery | Performs complex esophageal and hiatal hernia repairs, often for large paraesophageal defects |
| 207L00000X | Colon and Rectal Surgery | Occasionally involved when abdominal/complex foregut pathology overlaps |
| 208800000X | Pediatric Surgery | Not typical for this code (code not appropriate for newborn), but pediatric surgeons manage pediatric foregut procedures |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K44.3 | Diaphragmatic hernia with obstruction, unspecified | Hiatal hernias causing obstructive symptoms may indicate need for surgical repair |
K44.4 | Diaphragmatic hernia with gangrene, unspecified | Rare complication of incarcerated paraesophageal hernia requiring urgent repair |
K44.9 | Diaphragmatic hernia without obstruction or gangrene | General code for hiatal/diaphragmatic hernia when surgery is performed for symptomatic relief |
K21.0 | Gastro-esophageal reflux disease with esophagitis | Common accompanying diagnosis prompting fundoplication during hiatal hernia repair |
R13.10 | Dysphagia, unspecified | Symptom that may lead to evaluation and surgical repair when caused by hiatal hernia |
J69.0 | Pneumonitis due to food and vomit | Aspiration risk from severe reflux/large hernia that may prompt definitive surgical correction |
K44.2 | Diaphragmatic hernia with obstruction, organ-specific (hiatus) | Specific obstructive presentations of hiatal hernia often require operative management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43280 | Esophagoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing | Preoperative diagnostic evaluation for esophageal mucosa, reflux assessment |
43235 | Esophagogastroduodenoscopy, flexible, diagnostic | Common preoperative diagnostic procedure to assess esophagitis, Barrett mucosa, or hiatal hernia |
49002 | Exploratory laparotomy, with or without biopsy(s) (separate procedure) | May be performed if exploratory abdominal approach is required prior to definitive hiatal repair |
43283 | Esophagoscopy, flexible, with biopsy | Used when mucosal biopsies are performed during preoperative endoscopy |
43760 | Laparoscopy, surgical, repair of paraesophageal hiatal hernia, with or without fundoplication | Laparoscopic alternative to open repair; related as a minimally invasive approach option |