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Transoral lower esophageal myotomy, also known as peroral endoscopic myotomy (POEM), is a specialized therapeutic endoscopic procedure designed to address issues related to the lower esophagus. This procedure involves the precise cutting and removal of muscle tissue from the lower esophagus, utilizing an endoscope that is inserted through the mouth. The POEM technique is recognized as a less invasive alternative to the traditional laparoscopic Heller myotomy, which is often performed for similar indications. The primary aim of the POEM procedure is to treat achalasia, a rare motility disorder characterized by the esophagus's inability to effectively transport food and liquids into the stomach. In addition to achalasia, POEM may also be employed to manage various esophageal motility disorders, including spastic esophagus, diffuse esophageal spasm, jackhammer esophagus, and type 3 achalasia. During the procedure, an endoscope equipped with a camera and a specialized knife is carefully navigated through the mouth and into the esophagus, targeting the area of muscle tightness. A longitudinal incision is made in either the anterior or posterior section of the esophageal mucosa, allowing access to the submucosal layer while preserving the integrity of the mucosa. The endoscope is then advanced within the submucosa, extending slightly beyond the gastroesophageal junction (GEJ). The myotomy itself can be performed using either a full-thickness or selective muscle technique, with the latter focusing on the removal of the inner circular muscle layer at the GEJ while sparing the outer muscle layer. To ensure patient safety, any active bleeding that may occur during the procedure is promptly controlled before the incision is closed. Furthermore, POEM procedures can be combined with other separately reportable anti-reflux interventions, such as transoral incisional fundoplication, to mitigate the risk of post-surgical gastroesophageal reflux disease, a potential complication following the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The transoral lower esophageal myotomy (POEM) procedure is indicated for the treatment of specific esophageal motility disorders. The following conditions are explicitly recognized as indications for this procedure:
The transoral lower esophageal myotomy (POEM) procedure involves several critical steps to ensure effective treatment of the targeted esophageal conditions. The following outlines the procedural steps:
Following the transoral lower esophageal myotomy (POEM) procedure, patients typically require careful monitoring and post-procedure care. It is essential to observe for any complications, including bleeding or infection. Patients may experience some discomfort or pain in the throat and chest area, which is generally manageable with prescribed medications. Recovery time can vary, but many patients are able to resume normal activities within a few days. Additionally, it is important to follow up with the healthcare provider to assess the effectiveness of the procedure and to monitor for any potential development of gastroesophageal reflux disease (GERD), which may occur as a side effect of the surgery. If the POEM procedure is performed in conjunction with anti-reflux procedures, further post-operative care may be necessary to ensure optimal outcomes.
| Short Descr | TRANSORL LWR ESOPHGL MYOTOMY | Medium Descr | TRANSORAL LOWER ESOPHAGEAL MYOTOMY | Long Descr | Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic 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) | 1 - Statutory 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. | Endoscopic Base Code | 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2022-01-01 | Added | Code added |
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