How To Use CPT Code 43497

CPT 43497 describes a procedure known as lower esophageal myotomy, specifically performed through a transoral approach called peroral endoscopic myotomy (POEM). This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43497?

CPT 43497 is a code used to describe a specific procedure called lower esophageal myotomy, which is performed through a transoral approach known as peroral endoscopic myotomy (POEM). This procedure involves the use of an endoscope inserted through the mouth to cut muscle tissue in the lower esophagus, relaxing the muscles and potentially treating swallowing disorders.

2. Official Description

The official description of CPT code 43497 is: ‘Lower esophageal myotomy, transoral (i.e., peroral endoscopic myotomy [POEM]).’ It is important to note that this code should not be reported in conjunction with codes 32665, 43191, 43197, 43200, or 43235.

3. Procedure

1. During the procedure, the patient is appropriately prepped and anesthetized.
2. The healthcare provider inserts an endoscope through the patient’s mouth and into the esophagus.
3. Using the endoscope, the provider enters the submucosal space at the base of the esophagus and creates a tunnel.
4. Incisions are made into the muscle, a process known as myotomy, to relax the muscles and widen any narrowing in the space.
5. The provider closes the submucosal access site, typically using a clip.
6. The endoscope is then removed, completing the peroral endoscopic myotomy (POEM) procedure.

4. Qualifying circumstances

CPT 43497 is typically performed on patients with swallowing disorders that may benefit from the relaxation of the lower esophageal muscles. It is important to note that this code should not be reported in conjunction with codes 32665, 43191, 43197, 43200, or 43235.

5. When to use CPT code 43497

CPT code 43497 should be used when a healthcare provider performs a lower esophageal myotomy through a transoral approach, specifically using peroral endoscopic myotomy (POEM). It is important to ensure that the procedure meets the specific criteria outlined in the code description and that it is not reported with any of the excluded codes.

6. Documentation requirements

To support a claim for CPT 43497, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for a lower esophageal myotomy
• Details of the procedure, including the use of peroral endoscopic myotomy (POEM)
• Date and duration of the procedure
• Specific steps taken during the procedure, such as entering the submucosal space, making incisions, and closing the access site
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43497, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, this code should not be reported in conjunction with codes 32665, 43191, 43197, 43200, or 43235. It is crucial to review the documentation and accurately report the procedure to avoid any billing errors or denials.

8. Historical information

CPT code 43497 was added to the Current Procedural Terminology system on January 1, 2022. As of now, there have been no updates or changes to this code since its addition.

9. Examples

1. A patient with a swallowing disorder undergoes a lower esophageal myotomy using peroral endoscopic myotomy (POEM) to relax the muscles and improve their ability to swallow.
2. A healthcare provider performs a transoral lower esophageal myotomy using peroral endoscopic myotomy (POEM) on a patient with esophageal motility disorders.
3. Using an endoscope, a provider performs a peroral endoscopic myotomy (POEM) to treat a patient with achalasia, a condition characterized by difficulty swallowing.
4. A lower esophageal myotomy is performed through a transoral approach using peroral endoscopic myotomy (POEM) to alleviate symptoms in a patient with hypertensive lower esophageal sphincter.
5. A healthcare provider performs a peroral endoscopic myotomy (POEM) to treat a patient with diffuse esophageal spasm, a condition causing swallowing difficulties.
6. Using an endoscope, a provider performs a transoral lower esophageal myotomy using peroral endoscopic myotomy (POEM) to relax the muscles and improve swallowing function in a patient with Jackhammer esophagus.
7. A patient with a swallowing disorder undergoes a peroral endoscopic myotomy (POEM) to treat their esophageal motility disorder.
8. A healthcare provider performs a lower esophageal myotomy using peroral endoscopic myotomy (POEM) to alleviate symptoms in a patient with nutcracker esophagus.
9. Using an endoscope, a provider performs a transoral peroral endoscopic myotomy (POEM) to treat a patient with distal esophageal spasm.
10. A lower esophageal myotomy is performed through a transoral approach using peroral endoscopic myotomy (POEM) to relax the muscles and improve swallowing function in a patient with eosinophilic esophagitis.