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CPT®
39531

CPT® Code 39531
Deleted

Code deleted, to report see 43336 43337

Official Description

Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal, with dilation of stricture (with or without gastroplasty)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 39531 involves the surgical repair of a diaphragmatic hernia, specifically an esophageal hiatal hernia, utilizing a combined thoracoabdominal approach. This type of hernia occurs when the esophageal hiatus, the opening in the diaphragm through which the esophagus passes, is abnormally enlarged, allowing a portion of the stomach to protrude into the chest cavity. The combined thoracoabdominal 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. The surgical technique involves both a left posterolateral thoracotomy, which provides access to the esophagus, and an upper abdominal incision, which allows for direct access to the diaphragm and stomach. During the procedure, the surgeon meticulously dissects the tissues in both the upper abdomen and left chest, addressing any adhesions that may be present. The hernia sac is excised, and the anatomical structures, including the muscular origins of the diaphragm and the esophageal hiatus, are carefully identified. If there is a history of prior fundoplication, this is addressed as well. The procedure may also involve dilation of any esophageal strictures present, and if necessary, a gastroplasty is performed to ensure proper anatomical alignment and function. This comprehensive approach aims to restore normal anatomy and function, thereby alleviating symptoms associated with the hernia.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 39531 is indicated for the following conditions:

  • Diaphragmatic Hernia: The primary indication for this procedure is the presence of a diaphragmatic hernia, specifically an esophageal hiatal hernia, which occurs when the esophagus passes through an enlarged opening in the diaphragm.
  • Irreducible Hernia: This procedure is also indicated for patients with an irreducible hernia, which cannot be manually pushed back into the abdominal cavity.
  • Previous Surgical History: Patients who have undergone prior surgical interventions for diaphragmatic hernia may require this combined approach to effectively address complications or recurrences.
  • Esophageal Stricture: The presence of an esophageal stricture that necessitates dilation during the repair is another indication for this procedure.

2. Procedure

The surgical procedure for CPT® Code 39531 involves several critical steps to ensure effective repair of the diaphragmatic hernia:

  • Step 1: Incision and Exposure The surgeon begins by making a left posterolateral thoracotomy incision to access the esophagus. Simultaneously, an upper abdominal incision is made to expose the diaphragm and stomach, allowing for comprehensive access to the affected areas.
  • Step 2: Dissection and Adhesion Division Once the incisions are made, the surgeon performs simultaneous dissection in both the upper abdomen and left chest. This step is crucial for identifying and dividing any adhesions that may be present, which can complicate the surgical field.
  • Step 3: Hernia Sac Excision The hernia sac is then excised, which involves carefully removing the tissue that has protruded through the diaphragm. This step is essential for restoring normal anatomy.
  • Step 4: Identification of Anatomical Structures The muscular origins, known as the crura, of the diaphragm and the esophageal hiatus are identified. This identification is critical for ensuring proper repair and function of the diaphragm.
  • Step 5: Fundoplication Consideration If the patient has a history of prior fundoplication, this procedure is taken down to allow for proper anatomical alignment. The anatomic esophagogastric junction is then identified for further intervention.
  • Step 6: Esophageal Dilation If an esophageal stricture is present, a bougie is introduced into the esophagus and guided across the esophagogastric junction to dilate the stricture, facilitating better passage and function.
  • Step 7: Gastroplasty (if necessary) If the esophagogastric junction does not remain below the diaphragmatic hiatus after dilation, a gastroplasty is performed. This involves creating a gastric tube (neoesophagus) using the stomach wall, which is then sutured around the esophagus at the gastroesophageal junction (fundoplication).
  • Step 8: Closure of the Diaphragm Finally, the muscular origins of the diaphragm are approximated to create an esophageal hiatus of normal size, ensuring that the anatomical structures are restored to their proper positions.

3. Post-Procedure

After the completion of the procedure, patients typically require monitoring for any complications associated with the surgery. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper respiratory function due to the thoracic approach. Patients may also need to follow specific dietary guidelines as they recover, particularly if a gastroplasty was performed. The expected recovery time can vary based on individual patient factors and the complexity of the surgery, but close follow-up with the surgical team is essential to assess healing and address any concerns that may arise during the recovery period.
Short Descr REPAIR OF DIAPHRAGM HERNIA
Medium Descr RPR DIPHRG HRNA CMBN THORACOABDL W/DILAT STRIX
Long Descr Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal, with dilation of stricture (with or without gastroplasty)
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
Date
Action
Notes
2011-01-01 Deleted Code deleted, to report see 43336 43337
Pre-1990 Added Code added.
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Description
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