Summary & Overview
CPT 43333: Paraesophageal Hiatal Hernia Repair with Fundoplication and Mesh
CPT code 43333 represents open abdominal repair of a paraesophageal hiatal hernia with fundoplication and placement of mesh or other prosthetic. This is a major surgical procedure addressing anatomic displacement of the stomach adjacent to the esophagus and includes an anti-reflux component. The code is relevant nationally because it captures both hernia repair and prosthetic use in a clinical setting where choice of technique, device, and site of service influence utilization and payment patterns.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national perspective on billing and clinical context for this procedure across major commercial payers and the federal program.
Readers will find a concise overview of clinical intent and typical settings of care, an explanation of how the code is used in surgical billing, and where the code fits within related procedural coding. The report also highlights benchmarking considerations, common modifiers used with this procedure (listed separately), and policy-relevant issues such as prosthetic use documentation and inpatient versus outpatient site selection. Data availability and payer-specific coverage nuances are noted where present. Data not available in the input are identified explicitly in supporting sections.
Billing Code Overview
CPT code 43333 describes repair of a paraesophageal hiatal hernia performed through an abdominal incision with an included fundoplication and implantation of mesh or another prosthetic. The procedure addresses a hiatal hernia in which the stomach slides up adjacent to the esophagus and includes anatomical repair plus anti-reflux reconstruction (fundoplication).
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Service type: Open surgical repair of paraesophageal hiatal hernia with fundoplication and prosthetic implantation
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Typical site of service: Hospital inpatient or outpatient surgical facility (operating room) depending on clinical complexity and institutional protocols
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic paraesophageal hiatal hernia presenting with progressive gastroesophageal reflux, epigastric pain, early satiety, and intermittent postprandial regurgitation. Workup includes history and physical, upper endoscopy to evaluate esophagitis and gastric involvement, esophagram to define hernia anatomy, and esophageal manometry if reflux surgery is planned. After medical management (proton pump inhibitors, lifestyle modification) and imaging confirm a large paraesophageal component or recurrent obstructive symptoms, the surgical team schedules an open transabdominal repair with hiatal cruroplasty, mesh or prosthetic reinforcement, and a fundoplication (typical Nissen or partial wrap) to restore the gastroesophageal junction and reduce reflux. The procedure is performed in an operating room under general anesthesia with typical hospital inpatient recovery and perioperative care including aspiration precautions, pain control, DVT prophylaxis, and postoperative swallow evaluation before advancing diet.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no additional modifier applies and the full procedure is reported without special circumstances |
11 |