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Congenital hiatus hernia Congenital hiatal hernia; congenital diaphragmatic hernia (Q79.0); Congenital displacement of cardia through esophageal hiatus ICD-10-CM Diagnosis Code K40
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura.
For open esophageal repair, you should report 39502 (Repair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy and/or pyloroplasty, except neonatal). Note that this is the only hiatal hernia repair (other than the hernia repair described in the nissen procedure) that uses only an abdominal approach.
ICD-10-CM Diagnosis Code K46.0 [convert to ICD-9-CM] Unspecified abdominal hernia with obstruction, without gangrene
Q40. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Q40. 1 became effective on October 1, 2021.
ICD-10 code: K44. 9 Diaphragmatic hernia without obstruction or gangrene.
In a hiatal hernia (also called hiatus or diaphragmatic hernia), a portion of the stomach penetrates (herniates) through a weakness or tear in the hiatus of the diaphragm, the small opening that allows the esophagus to pass from the neck and chest to its connection with the stomach.
CPT43337Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis43338Esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) [when performed with open repair of paraesophageal hernia]32 more rows
01 - Gastro-esophageal reflux disease with esophagitis, with bleeding is a sample topic from the ICD-10-CM. To view other topics, please log in or purchase a subscription. ICD-10-CM 2022 Coding Guide™ from Unbound Medicine.
ICD-10 code R12 for Heartburn is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .
The hiatus is an opening in the diaphragm - the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening.
Type 3 (mixed, sliding, and paraesophageal hiatal hernia) is the EGJ and stomach is located above the diaphragm and 2 cm or more of the fundus is located cephalad to the lower esophageal sphincter and esophagus.
Unlike ventral hernias, which protrude through the abdominal wall, a hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest.
CPT 43281 is separately payable when performed with a bariatric procedure, CPT 43280 is not. The difference between the two codes is that in 43281 the hernia sac is removed and then the area is repaired; in 43280 the hernia is only repaired via sutures.
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Repair of an asymptomatic or incidentally identified hiatal hernia (CPT codes 43280, 43281, 43282, 43289, 43499 or 43659) will be denied when billed with bariatric surgery (CPT codes 43770-43775 or 43842-43848).
The Bochdalek hernia, also known as a postero-lateral diaphragmatic hernia, is the most common manifestation of CDH, accounting for more than 95% of cases.
Diaphragmatic hernia is a birth defect where there is a hole in the diaphragm (the large muscle that separates the chest from the abdomen). Organs in the abdomen (such as intestines, stomach, and liver) can move through the hole in the diaphragm and upwards into a baby's chest.
The 2 most common types of diaphragmatic hernia are:Bochdalek hernia. This involves the side and back of the diaphragm. The stomach, liver, spleen, or intestines move up into your child's chest cavity.Morgagni hernia. This involves the front part of the diaphragm.
With a hiatal hernia, this can occur fairly easily since the following conditions show similar symptoms: Angina, a heart condition in which heart muscles don't get the oxygen they need. Indigestion, which results in burping, vomiting, and heartburn. Biliary colic, in which a gallstone blocks the bile duct.
For open esophageal repair, you should report 39502 (Repair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy and/or pyloroplasty, except neonatal). Note that this is the only hiatal hernia repair (other than the hernia repair described in the nissen procedure) that uses only an abdominal approach.
Therefore, to describe a procedure of this type, you must select the unlisted procedure code 39599 (Unlisted procedure, diaphragm).
We use unlisted code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) to represent the laparoscopic hiatal hernia repair. I understand the code indicated above is of the diaphragm, but the 49659 is for hernia's and is specifically laparoscopic; therefore, we chose to use this code rather than 39599 (Unlisted procedure, diaphragm). We use the unlisted procedure code when all they do is reduce the hernia and suture the left and right crura.
For a laparascopic paraesophageal repair, you must resort once again to 39599 because CPT does not contain a specific code to describe this procedure. This is some more info on the Lap hiatal hernia codes, this one is for the 2010 code set:
An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid. The hiatal hernia is internal, at the esophageal hiatus where the esophagus transits the chest cavity to the abdominal cavity. L.
If they do fundoplication, the hiatal hernia repair is included in the 43280 (Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)). See info in the CPT (R) Assistant Detail, Year: 2012, Issue: February, Pages: 3-7, Title: Repair, Paraesophageal Hiatal Hernia (Including Fundoplication) and also Year: 2002, Issue: December, Pages: 1, Title: Laparoscopic Nissen Fundoplasty. The last article listed specifically states, " The procedure (43280) also includes repair of coexisting hiatal hernia, a common occurrence in these cases".
Pay attention: While performing a Nissen, the surgeon may encounter an enlarged diaphragmatic hiatus and subsequently reduce the hiatus size. You should not consider this a paraesophageal repair, and you should code only for the nissen procedure.
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia eng …
Sliding hiatal hernia ( Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus.
Diagnosis. The diagnosis of a hiatal hernia is typically made through an upper GI series, endoscopy or high resolution manometry . A large hiatal hernia on chest X-ray marked by open arrows in contrast to the heart borders marked by closed arrows.
A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back ...
Sliding hernias are the most common type and account for 95% of all hiatal hernias. (C) Type II: A type II hernia, also known as a paraesophageal or rolling hernia, occurs when the fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus.
Hiatal hernia has often been called the "great mimic" because its symptoms can resemble many disorders. Among them, a person with a hiatal hernia can experience dull pains in the chest, shortness of breath (caused by the hernia's effect on the diaphragm ), heart palpitations (due to irritation of the vagus nerve ), ...
Green is the esophagus, red is the stomach, purple is the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is a pre-stage, C is a sliding hiatal hernia, and D is a paraesophageal (rolling) type. Four types of esophageal hiatal hernia are identified:
Incidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal hernia. Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter (LES). 95% of these are "sliding" hiatal hernias, in which the LES protrudes above the diaphragm along with the stomach, and only 5% are the "rolling" type (paraesophageal), in which the LES remains stationary, but the stomach protrudes above the diaphragm.
Type III: Type III hernias have elements of both types I and II hernias. With progressive enlargement of the hernia through the hiatus, the phrenoesophageal ligament stretches, displacing the gastroesophageal junction above the diaphragm, thereby adding a sliding element to the type II hernia.