Summary & Overview
CPT 43337: Paraesophageal Hiatal Hernia Repair with Fundoplication
CPT code 43337 denotes an open repair of a paraesophageal hiatal hernia performed through abdominal and chest incisions that includes fundoplication and implantation of mesh or another prosthetic. This complex thoracoabdominal procedure is clinically significant because it treats large or complicated hiatal hernias at risk for volvulus, obstruction, or recurrent reflux and typically requires hospital-based surgical care and perioperative resources. Nationally, the code is relevant for surgical specialties managing foregut disease and for payers overseeing high-cost inpatient procedures.
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, typical site-of-service considerations, and the administrative context for billing this invasive surgical code. The publication summarizes common modifiers and coding considerations, outlines where to look for clinical documentation to support medical necessity, and highlights related procedure groupings for claim validation. Practical benchmarks and policy updates are presented for payers and provider billing teams to align coding, coverage rules, and hospital reimbursement workflows.
Data not available in the input: Associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific reimbursement benchmarks.
Billing Code Overview
CPT code 43337 describes open repair of a paraesophageal hiatal hernia performed through abdominal and chest incisions with concurrent fundoplication and implantation of mesh or another prosthetic. The procedure addresses a hiatal hernia in which the stomach slides up next to the esophagus and includes reconstruction of the hiatal defect and anti-reflux reinforcement with fundoplication.
Service type: Invasive surgical repair with prosthetic implantation and anti-reflux procedure
Typical site of service: Inpatient hospital or operating room setting (abdominal/thoracic surgical suite)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult (often over age 50) presenting with progressive gastroesophageal reflux symptoms, epigastric or chest discomfort, postprandial fullness, regurgitation, or anemia from chronic blood loss. Diagnostic workup includes upper endoscopy showing a paraesophageal hiatal hernia with gastric herniation adjacent to the distal esophagus, barium swallow to characterize the hernia, and esophageal manometry/pH testing when indicated. The surgical workflow for 43337 begins with preoperative evaluation and optimization, anesthesia induction, and a combined abdominal and thoracic surgical approach via laparotomy or thoracoabdominal incision. The provider reduces the herniated stomach, repairs the hiatal defect, reinforces the crural repair with implantable mesh or other prosthetic, and performs a fundoplication to restore the gastroesophageal valve. Intraoperative steps include mobilization of the esophagus, assessment of stomach viability, placement of prosthetic material, and creation of a partial or complete fundoplication. Postoperative care includes monitoring for respiratory complications, pain control, early ambulation, swallow evaluation prior to oral intake, and follow-up imaging or endoscopy as clinically indicated. Typical site of service is an inpatient hospital operating room; ambulatory surgical centers are less common for this combined abdominal/thoracic approach.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |