CPT® Code 43328

A partial or complete esophagogastric fundoplasty is a surgical procedure aimed at addressing a sliding hiatal hernia, which occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This procedure can be performed using different approaches, specifically an abdominal approach or a transthoracic approach. In the abdominal approach, as described in CPT® Code 43327, the surgeon utilizes a complete (360-degree) wrap, known as a Nissen fundoplication, or a partial (270-degree) wrap, referred to as a Toupet fundoplication. The complete fundoplasty involves fully encircling the esophagus with the fundus (the upper part of the stomach), while the partial fundoplasty entails a looser wrap that only partially encircles the esophagus. In contrast, CPT® Code 43328 describes the transthoracic approach, which may utilize techniques such as the Belsey IV or Belsey Mark IV (BMIV). This method involves making an incision in the chest above the diaphragm, allowing the stomach to be mobilized and pulled into the thoracic cavity. The fundus is then partially wrapped around the esophagus and secured to the esophageal muscle layer. Additionally, the Hill procedure is another technique that may be employed, which focuses on anchoring the stomach to the diaphragm to prevent future herniation and involves suturing the diaphragm's crura to narrow the hiatus. Overall, these procedures are critical for alleviating symptoms associated with hiatal hernias and restoring normal anatomical function.