Summary & Overview
CPT 43334: Paraesophageal Hiatal Hernia Repair with Fundoplication
CPT code 43334 represents a thoracic surgical procedure to repair a paraesophageal hiatal hernia with an included fundoplication, performed through a chest incision without implantation of mesh or other prosthetics. This code is used for adult and pediatric patients except newborns and is relevant to thoracic and general surgeons, hospital billing departments, and payers managing surgical benefit policies. Nationally, accurate coding for complex hiatal hernia repairs influences payment, quality measurement, and case mix reporting for inpatient and outpatient surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and setting, common billing modifiers, and which payers are typically involved. The publication details billing benchmarks and reimbursement considerations where available, clarifies clinical context for appropriate code use, and highlights policy updates or coverage nuances that affect payment and prior authorization practices.
This resource is intended to help revenue cycle professionals, surgical coders, and policy analysts understand the use and implications of CPT code 43334 at a national level. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 43334 describes a surgical repair of a paraesophageal hiatal hernia performed through a chest incision with an included fundoplication. The procedure addresses a stomach that slides up beside the esophagus and explicitly excludes the use of mesh or other prosthetic implantation. This code is not appropriate for a newborn.
-
Service type: Surgical repair of paraesophageal hiatal hernia with fundoplication via thoracic (chest) approach
-
Typical site of service: Inpatient or outpatient hospital operating room (thoracic surgery service or general surgery service depending on facility capabilities)
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents with progressive gastroesophageal reflux symptoms, postprandial fullness, and intermittent retching. Imaging (barium swallow and CT) demonstrates a large paraesophageal hiatal hernia with upward migration of the gastric fundus adjacent to the distal esophagus and associated symptomatic obstruction. Endoscopy excludes malignancy and assesses gastric mucosa. The surgical team elects an open transthoracic repair through a chest incision with reduction of the herniated stomach and formation of a fundoplication to restore the gastroesophageal junction. The typical clinical workflow includes preoperative evaluation and optimization, anesthesia assessment, operative reduction of the hernia sac, closure/repair of the hiatal defect without prosthetic mesh, creation of a fundoplication (partial or complete as clinically indicated), intraoperative confirmation of repair integrity, postoperative monitoring in recovery or inpatient surgical unit, and scheduled postoperative follow-up for wound and functional assessment. This procedure is performed in an inpatient operating room or ambulatory surgical center with thoracic or general surgery capabilities and is not coded for newborn patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (Placeholder - payer-specific) | Use only if required by payer for specific billing scenarios per payer rules. |