CPT® Code 0241T | Case2Code

Official Description

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)

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 affecting the movement and coordination of the esophagus during swallowing. High-resolution esophageal pressure topography (HREPT) is a sophisticated technique that combines high-resolution manometry with pressure topography plots to provide detailed insights into esophageal function. This method allows for the monitoring of esophageal peristalsis along the entire length of the esophagus, as well as at the gastroesophageal junction, which is the area where the esophagus meets the stomach. The pressure measurements obtained during HREPT are transformed into spectral colors, enabling healthcare professionals to easily identify differences in contractility. This visual representation enhances the sensitivity of the test, particularly in detecting impaired relaxation of the esophagogastric junction, which is a key factor in diagnosing conditions such as achalasia. HREPT has proven to be more accurate than traditional methods in identifying achalasia, a condition characterized by difficulty in swallowing due to the failure of the esophagus to properly relax. The increased sensitivity of HREPT has led to the classification of three distinct subtypes of achalasia 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 marked by intermittent contractions of the esophagus. To conduct an HREPT study, a specialized catheter equipped with sensors is inserted through the nostril and advanced through the pharynx into the esophagus. The patient is instructed to swallow to facilitate the catheter's advancement. Once the catheter tip reaches the gastroesophageal junction, pressure measurements are recorded along the entire esophagus. Following this, the catheter is withdrawn, and the physician interprets the results, providing a comprehensive written evaluation of the esophageal motility. In the context of CPT® Code 0241T, the HREPT study is enhanced by the use of a stimulant, such as mecholyl, or by perfusion with an acid or alkali solution, which further aids in assessing esophageal contractility and identifying any dysfunctions.

1. Indications

Esophageal motility studies, including high-resolution esophageal pressure topography (HREPT), are indicated for various conditions and symptoms related to esophageal function. The following are the explicitly provided indications for performing this procedure:

Difficulty Swallowing (Dysphagia) - Patients experiencing challenges in swallowing may require evaluation to determine the underlying cause.
Chest Pain - Unexplained chest pain that may be related to esophageal motility disorders can be assessed through this study.
Reflux Symptoms - Individuals with gastroesophageal reflux disease (GERD) may undergo this study to evaluate esophageal function and motility.
Suspected Achalasia - Patients suspected of having achalasia, a condition characterized by the failure of the esophagus to relax, are prime candidates for this evaluation.
Diffuse Esophageal Spasm - This study can help identify diffuse esophageal spasm, a condition marked by intermittent contractions of the esophagus.

2. Procedure

The procedure for conducting a high-resolution esophageal pressure topography (HREPT) study involves several key steps, each critical for obtaining accurate results. The following outlines the procedural steps as described:

Step 1: Catheter Insertion - A specialized catheter containing high-resolution manometry sensors is carefully inserted through the patient's nostril. The healthcare provider advances the catheter through the pharynx and into the esophagus, ensuring proper placement for accurate measurement.
Step 2: Patient Swallowing - To facilitate the advancement of the catheter and to ensure it reaches the gastroesophageal junction, the patient is instructed to swallow. This action helps position the catheter tip correctly for optimal pressure measurement.
Step 3: Pressure Measurement - Once the catheter tip is positioned at the gastroesophageal junction, pressure measurements are taken along the entire length of the esophagus. This data collection is crucial for evaluating esophageal motility and identifying any abnormalities.
Step 4: Catheter Withdrawal - After the pressure measurements are completed, the catheter is gently withdrawn from the esophagus. This step concludes the data collection phase of the procedure.
Step 5: Evaluation and Reporting - The physician reviews the collected test results, analyzing the pressure data to assess esophageal motility. A comprehensive written evaluation is then provided, detailing the findings and any identified motility disorders.
Step 6: Stimulation or Perfusion (for CPT® Code 0241T) - In the context of CPT® Code 0241T, the HREPT evaluation is performed with the addition of a stimulant, such as mecholyl, or through the perfusion of an acid or alkali solution. This step is designed to further assess the esophageal contractility response to these substances.

3. Post-Procedure

After the completion of the high-resolution esophageal pressure topography (HREPT) study, patients may experience some mild discomfort due to the catheter insertion and the perfusion of solutions. It is important for the physician to provide post-procedure care instructions, which may include monitoring for any adverse reactions to the stimulant or perfusion solutions. Patients are typically advised to report any significant discomfort or pain experienced during the procedure. The physician will review the findings from the study and discuss the results with the patient, outlining any necessary follow-up actions or additional testing that may be required based on the evaluation.

Short Descr	ESOPH MOTILITY W/STIM/PERF
Medium Descr	ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R
Long Descr	Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)
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	Items and Services Packaged into APC Rates
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