Summary & Overview
CPT 43336: Open Repair of Paraesophageal Hiatal Hernia with Fundoplication
Headline: CPT code 43336: Open repair of paraesophageal hiatal hernia with fundoplication
CPT code 43336 designates an open abdominal and thoracic surgical repair of a paraesophageal hiatal hernia that includes fundoplication and explicitly excludes implantation of mesh or other prosthetic devices. The code captures complex foregut surgery intended to reduce herniated stomach tissue and restore esophagogastric anatomy, often performed for symptomatic or complicated hiatal hernias.
This code is relevant nationally because it defines coverage and billing for major surgical management of paraesophageal hernias, which carry implications for hospital resource use, operative planning, and payer reimbursement policies. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical and billing definition of the code, typical sites of service, and the contexts in which 43336 is applied. The publication summarizes benchmarks for utilization and reimbursement where available, highlights policy considerations that affect claims adjudication for major open foregut procedures, and outlines clinical context useful for coding accuracy. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 43336 describes an open surgical repair of a paraesophageal hiatal hernia performed through combined abdominal and thoracic incisions. The procedure includes fundoplication to restore the gastroesophageal junction and prevent reflux, and explicitly involves no mesh or other prosthetic implantation. This code is not appropriate for a newborn.
Service type: Open surgical repair with fundoplication for paraesophageal hiatal hernia.
Typical site of service: Inpatient hospital operating room or surgical center for major abdominal/thoracic procedures.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult (often middle-aged or older) presenting with symptomatic paraesophageal hiatal hernia characterized by gastroesophageal reflux, intermittent postprandial chest pressure, dysphagia, or anemia from occult bleeding. Preoperative workup includes history and physical, upper endoscopy (esophagogastroduodenoscopy) to evaluate mucosal injury and hiatal anatomy, esophageal manometry to assess motility if considered for fundoplication, and cross-sectional imaging or barium swallow to define hernia size. The patient is optimized medically and scheduled for a combined abdominal and thoracic approach under general anesthesia. Intraoperative steps include reduction of the herniated stomach, crural repair without mesh, and a fundoplication (eg, Nissen or partial wrap) performed through abdominal and chest incisions as described by 43336. Postoperative care includes monitoring in a PACU or surgical unit, pain control, swallow assessment prior to diet advancement, and discharge planning with activity and diet instructions. Typical sites of service are an inpatient hospital operating room or an ambulatory surgical center for selected cases. Procedure coding captures the primary open or combined approach repair with fundoplication and no prosthetic implantation; this code is not appropriate for newborn patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |