New Medical Billing Nissen Code

Medical billing for a redo surgery originally done several years earlier can get a bit hazy. A Redo Nissen Surgery performed for a surgery originally done twelve years earlier should be coded the same as a regular laparoscopic Nissen procedure. The medical billing current procedural terminology code 43280 is appropriate for a redo Nissen surgery.

The medical billing code CPT 43280 means: Laparoscopy, surgical, esophagogastric fundoplasty. All medical billing, whether a redo or an initial Nissen surgery would be billed using this code. However, when surgery is performed as a redo, problems may arise. For example, the first surgery may have been considerably difficult. Perhaps there was excessive scarring or perhaps the physician had to wrap and unwrap a previous fundoplasty. When the surgeon goes in to correct these problems, extra work is obviously involved.

The best way to get medical billing reimbursement for extra surgical work is to append your code with modifier 22 (Unusual procedural services). This will show the insurance payer that additional work was done for the Current Procedural Terminology 43280. Many times the medical billing modifier 22 raises red flags. You can lower these flags by including a cover letter that clearly explains what was unusual about the surgery. In this letter you should also specifically request additional medical billing reimbursement. You should then attach a complete operative report.

Medical billing modifiers were designed for a reason. Although you may think the use of modifiers is frivolous, sometimes it is necessary for proper reimbursement. Payers will never know what lengths your surgeons go to during different surgeries or procedures unless you tell them. Attaching additional medical billing information paints a clearer picture for these payers. The only time medical billing modifiers are frivolous is when they are abused and overused.

View all Articles by: Melissa Clark, CCS-P