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The procedure described by CPT® Code 39520 refers to the surgical repair of a diaphragmatic hernia, specifically an esophageal hiatal hernia, using a transthoracic approach. An esophageal hiatal hernia occurs when the esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen, becomes enlarged. This enlargement allows a portion of the upper stomach to protrude into the chest cavity, which can lead to various complications, including gastroesophageal reflux disease (GERD) and difficulty swallowing. The transthoracic approach is particularly indicated for patients who have previously undergone surgery for a diaphragmatic hernia or for those presenting with an irreducible hernia, which cannot be pushed back into the abdomen. During the procedure, a left posterolateral thoracotomy is performed to access the thoracic cavity, allowing the surgeon to mobilize the esophagus up to the aortic arch. The lower esophagus and the esophageal sphincter are then repositioned back into the abdominal cavity. A fundoplication is performed, where the fundus of the stomach is sutured around the esophagus at the gastroesophageal junction, which helps to prevent reflux. Finally, the defect in the diaphragm is repaired, and the chest is closed, with a chest tube placed if necessary to facilitate drainage and prevent complications.
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The procedure is indicated for patients presenting with specific conditions related to esophageal hiatal hernias. These include:
The surgical procedure for CPT® Code 39520 involves several critical steps, which are detailed as follows:
Post-procedure care following the repair of an esophageal hiatal hernia typically involves monitoring for complications and ensuring proper recovery. Patients may require a period of hospitalization for observation, especially to assess for any respiratory issues or complications related to the chest tube. Pain management is also an important aspect of post-operative care. Patients are usually advised to follow a specific diet and may need to avoid certain activities for a period to allow for healing. Follow-up appointments are essential to monitor the surgical site and ensure that the esophagus and diaphragm are functioning correctly after the procedure.
| Short Descr | REPAIR OF DIAPHRAGM HERNIA | Medium Descr | RPR DIPHRG HRNA ESOPHGL HIATAL TTHRC | Long Descr | Repair, diaphragmatic hernia (esophageal hiatal); transthoracic | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | Not applicable/unspecified. | CCS Clinical Classification | 86 - Other hernia repair |
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