2025 CPT code 43497
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Transoral lower esophageal myotomy (POEM) to relax esophageal muscles and improve swallowing.
Modifiers may apply depending on the circumstances of the procedure.Consult the CPT manual for appropriate modifier use.
POEM is medically necessary for patients with achalasia, diffuse esophageal spasm, or other esophageal motility disorders causing significant dysphagia refractory to other conservative treatments.The procedure aims to improve swallowing function and quality of life.Medical necessity is established through appropriate clinical documentation.
The physician performs the procedure under appropriate anesthesia and preparation.This includes inserting the endoscope, creating the submucosal tunnel, performing the myotomy, closing the access site, and removing the endoscope. Post-operative care may be included depending on the specific facility and billing practices.
- Surgery
- Surgery > Surgical Procedures on the Digestive System > Other Procedures on the Esophagus
In simple words: This procedure uses a thin, flexible tube with a camera (endoscope) inserted through the mouth to reach the lower esophagus.Small cuts are made in the esophageal muscles to widen the passageway and improve swallowing.
Peroral endoscopic myotomy (POEM) involves the insertion of an endoscope through the mouth into the lower esophagus.A submucosal tunnel is created, and incisions are made into the esophageal muscle (myotomy) to relax the muscle and widen any narrowing.The submucosal access site is closed, typically with a clip. The procedure aims to treat dysphagia (swallowing difficulties) by facilitating the passage of food and liquids into the stomach.
Example 1: A 55-year-old male patient presents with progressive dysphagia (difficulty swallowing) due to achalasia, a condition characterized by impaired esophageal peristalsis and lower esophageal sphincter dysfunction. POEM is performed to relieve the esophageal obstruction. , A 40-year-old female with long-standing symptoms of dysphagia secondary to diffuse esophageal spasm undergoes a POEM to improve esophageal motility and swallowing function., A 60-year-old patient with previous unsuccessful dilation for esophageal stricture, who continues to experience dysphagia, is treated with a POEM.
Detailed history and physical examination documenting the patient's symptoms and medical necessity for POEM.Preoperative and postoperative assessments, including endoscopic findings, imaging studies (e.g., barium swallow, endoscopy), and pathology reports if biopsies were taken.Complete operative report including the approach, extent of myotomy, and any complications.Patient's response to the procedure, including improvement in dysphagia.
** This information is for guidance only and should not be considered a substitute for professional medical coding advice. Always refer to the most current CPT® codebook and other relevant coding resources for the most accurate and up-to-date information.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: Information not available in source
- Global Days: Information not available in source
- Payment Status: Active
- Modifier TC rule: Information not available in source
- Fee Schedule: Information not available in source
- Specialties:Gastroenterology, Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient