Health Information Management

CPT code 43280 not on inpatient-only list

APCs Insider, August 31, 2007

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QUESTION: Was the Laparoscopic Nissen Fundoplication ever considered to be an inpatient-only procedure?  Not too long ago I went into the outpatient coding module and entered all of the correct codes for this procedure. After doing this, I performed a coding check, and the software indicated that it was an inpatient-only procedure. 
I was using procedure code 44.67 (Laparoscopic procedures for creation of esophagogastric sphincteric competence) and CPT code 43280 (Laparoscopy, surgical, esophagogastric fundoplasty [eg. Nissen, Toupet procedures]). Now, when I put these same codes in the outpatient data entry module, it does not give me that warning.  How do you suggest that we report this procedure? 
ANSWER: Reviewing the OPPS Addendum B files from the year 2000 and forward, it appears that 43280 has always been a status indicator "T" procedure and has never been included on the inpatient-only procedure list. This means that physicians may perform 43280 (laparoscopic fundoplasty) in the outpatient setting, and Medicare will reimburse hospitals for this procedure under the OPPS.
According to the most recent version of OPPS Addendum B (July 2007), CPT code 43280 groups to APC 0132 with a payment rate of $4,333.90.

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