CPT® Code 0240T | Case2Code

Official Description

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography

Common Language Description

Esophageal motility studies are diagnostic procedures that assess the muscle contractions within the esophagus and at the gastroesophageal junction. These studies are crucial for understanding various esophageal disorders, particularly those related to motility dysfunction. The high-resolution esophageal pressure topography (HREPT) is a sophisticated technique that enhances the traditional manometric study by integrating high-resolution manometry with pressure topography plots. This method allows for detailed monitoring of esophageal peristalsis throughout the entire length of the esophagus and at the gastroesophageal junction, providing a comprehensive view of esophageal function. The pressure measurements obtained during the study are transformed into spectral colors, which visually represent differences in contractility, making it easier to identify abnormalities. HREPT has demonstrated improved sensitivity in detecting impaired relaxation of the esophagogastric junction and has proven to be more accurate in diagnosing conditions such as achalasia. This technique has led to the classification of achalasia into three distinct subtypes based on the contractile function of the esophageal body: classic achalasia, achalasia with esophageal compression, and spastic achalasia. Additionally, HREPT is effective in identifying diffuse esophageal spasm, a condition characterized by intermittent contractions of the esophagus. The procedure involves the insertion of a specialized catheter equipped with HREPT sensors through the nostril and into the esophagus, where pressure measurements are taken during swallowing. Following the procedure, the physician interprets the results and generates a detailed report on the patient's esophageal motility.

1. Indications

Esophageal motility studies, specifically high-resolution esophageal pressure topography (HREPT), are indicated for the evaluation of various esophageal conditions and symptoms. The following are the primary indications for performing this procedure:

Achalasia - A condition characterized by the inability of the esophagus to properly move food into the stomach, often leading to difficulty swallowing.
Diffuse esophageal spasm - A disorder where the esophagus experiences intermittent contractions, causing chest pain and swallowing difficulties.
Impaired esophagogastric junction relaxation - A condition where the junction between the esophagus and stomach does not relax properly, affecting the passage of food.
Other esophageal motility disorders - Various other conditions that may affect the normal contractions of the esophagus and require further evaluation.

2. Procedure

The procedure for high-resolution esophageal pressure topography (HREPT) involves several key steps to ensure accurate assessment of esophageal motility. The following outlines the procedural steps:

Step 1: Catheter Insertion - A specialized catheter containing high-resolution pressure sensors is inserted through the patient's nostril. The catheter is carefully advanced through the pharynx and into the esophagus, allowing for precise placement.
Step 2: Catheter Advancement - The patient is instructed to swallow, which aids in the advancement of the catheter into the esophagus. This step is crucial for positioning the catheter tip at the gastroesophageal junction.
Step 3: Pressure Measurement - Once the catheter is properly positioned, pressure measurements are taken along the entire length of the esophagus and at the gastroesophageal junction. This data collection is essential for evaluating esophageal motility.
Step 4: Catheter Withdrawal - After the pressure measurements are completed, the catheter is gently withdrawn from the esophagus.
Step 5: Interpretation and Reporting - The physician reviews the collected data and interprets the results, providing a comprehensive written evaluation of the esophageal motility findings.

3. Post-Procedure

After the completion of the high-resolution esophageal pressure topography (HREPT) procedure, patients may experience some temporary discomfort due to the catheter insertion. It is important for the physician to monitor the patient for any immediate adverse reactions. Patients are typically advised to resume normal activities unless otherwise directed. The physician will provide a detailed report of the findings, which may include recommendations for further evaluation or treatment based on the results of the study. Follow-up appointments may be scheduled to discuss the findings and any necessary interventions.

Short Descr	ESOPH MOTILITY 3D TOPOGRAPHY
Medium Descr	ESOPH MOTILITY 3D PRESSURE TOPOGRAPHY W/I&R
Long Descr	Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No 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)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	9 - Other Medical Items or Services
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	97 - Other gastrointestinal diagnostic procedures