2025 CPT code 32665
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Surgical thoracoscopy with esophagomyotomy (Heller type).
Modifiers may be applicable depending on the circumstances of the procedure. Consult the AMA CPT manual for detailed information on appropriate modifier usage. Examples include modifiers for multiple procedures (51), reduced services (52), or assistant surgeon (80).
Medical necessity for this procedure is established by the presence of symptoms and diagnostic evidence of esophageal motility disorders that significantly impair swallowing and quality of life.Alternative treatment modalities should be documented as having failed or being inappropriate for the specific patient.
The clinical responsibility includes patient preparation and anesthesia, making incisions for instrument insertion, using the thoracoscope and other instruments to perform the myotomy, controlling bleeding, and managing post-operative care.
In simple words: The doctor uses a tiny camera and special tools inserted through small incisions in the chest to cut and relax the muscles in the food tube (esophagus) to help with swallowing problems.
This CPT code represents surgical thoracoscopy with esophagomyotomy (Heller type).The procedure involves using a thoracoscope to access and incise the muscular wall of the esophagus.A small incision is made to insert a trocar or port, allowing instruments to access the surgical area. An endoscope (thoracoscope) is inserted to view the chest cavity, and additional incisions may be made for more ports and instruments.A lighted tube or endoscope might be inserted through the mouth into the esophagus to improve visualization for the myotomy (cutting the muscle of the esophagus). The provider then maneuvers the tools to the surgical site and performs the myotomy, controlling bleeding throughout. Finally, instruments are removed, and the lung is expanded if necessary. This procedure is often performed for esophageal disorders that impede normal swallowing, such as achalasia.
Example 1: A patient presents with symptoms of achalasia, including difficulty swallowing and chest pain.Surgical thoracoscopy with esophagomyotomy is performed to relieve the esophageal obstruction. , A patient with a history of esophageal dysmotility undergoes a surgical thoracoscopy and Heller myotomy to improve esophageal function and alleviate swallowing difficulties., A patient with severe esophageal spasms causing significant discomfort and difficulty swallowing food undergoes a surgical thoracoscopy and esophagomyotomy to reduce the spasms and improve swallowing function.
Thorough preoperative evaluation, including history, physical examination, and diagnostic tests (e.g., barium swallow, endoscopy) to confirm the diagnosis. Detailed operative report describing the procedure, including the type of incision, instruments used, extent of myotomy, and intraoperative complications. Postoperative management plan, including pain control, dietary recommendations, and follow-up appointments. Pathology report if any tissue samples were obtained.
** This procedure may be performed using different approaches.The choice of approach (e.g., open or VATS) should be documented and considered when determining reimbursement.
- Revenue Code: P8I (ENDOSCOPY - OTHER)
- RVU: The relative value units (RVUs) for this code will vary based on geographic location, facility type (inpatient/outpatient), and other factors.Consult the CMS Physician Fee Schedule or a relevant pricing database for specific RVU values and payment rates.
- Global Days: The global surgical period for this procedure is not explicitly defined in the provided data.Consult the CMS guidelines or other relevant resources for determination of the appropriate global period for payment.
- Payment Status: Active
- Modifier TC rule: This code does not have a technical component (TC) modifier.
- Fee Schedule: Historical fee schedule data is not provided. Consult the CMS Physician Fee Schedule database for historical payment rates.
- Specialties:Thoracic Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center