CPT® Code 91011

Code deleted, to report see 91013 in conjunction with 91010

Official Description

Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; with mecholyl or similar stimulant

Common Language Description

The CPT® Code 91011 refers to an esophageal motility study, specifically a manometric study of the esophagus and/or gastroesophageal junction, which is conducted with the administration of a stimulant such as mecholyl or a similar agent. This diagnostic procedure is essential for evaluating the function of the esophagus, particularly in patients experiencing swallowing difficulties or non-cardiac chest pain. The primary aim of the esophageal motility study is to assess the muscle contractions within the esophagus, which can provide critical insights into various esophageal disorders. One of the most common conditions diagnosed through this procedure is esophageal achalasia, a disorder characterized by the inability of the lower esophageal sphincter to relax properly, coupled with uncoordinated contractions of the thoracic esophagus. This results in a functional obstruction, making it difficult for food and liquids to pass into the stomach. During the procedure, a catheter equipped with a manometer is inserted through one of the nostrils, which is first numbed with lidocaine to minimize discomfort. The catheter is carefully advanced through the pharynx and into the esophagus, with the patient asked to swallow to facilitate the catheter's movement. The study involves measuring the contractility of the lower esophageal sphincter and the mid-esophagus during the swallowing process. In the case of CPT® Code 91011, the procedure is enhanced by the administration of mecholyl, a cholinergic agent that stimulates increased secretions and smooth muscle contractions. This response is particularly useful in identifying esophageal contractility dysfunction, as patients typically exhibit heightened smooth muscle contractions when exposed to mecholyl. Overall, the esophageal motility study, especially when combined with stimulant administration, plays a crucial role in diagnosing and understanding esophageal motility disorders.

1. Indications

The esophageal motility study (CPT® Code 91011) is indicated for patients presenting with specific symptoms or conditions that warrant further investigation of esophageal function. The following indications are explicitly recognized for this procedure:

Swallowing Difficulties - Patients experiencing dysphagia or difficulty swallowing may require this study to determine underlying motility issues.
Non-Cardiac Chest Pain - Individuals with chest pain not attributable to cardiac causes may benefit from this evaluation to rule out esophageal disorders.
Suspected Esophageal Achalasia - This condition, characterized by the failure of the lower esophageal sphincter to relax, is a primary focus of the motility study.

2. Procedure

The procedure for CPT® Code 91011 involves several detailed steps to ensure accurate assessment of esophageal motility. The following procedural steps are performed:

Step 1: Preparation - The patient is prepared for the procedure, which includes numbing one nostril with lidocaine to minimize discomfort during catheter insertion.
Step 2: Catheter Insertion - A catheter containing a manometer is carefully passed through the numbed nostril and advanced through the pharynx into the esophagus. The patient is instructed to swallow to assist in the catheter's advancement.
Step 3: Measurement of Lower Esophageal Sphincter - Once the catheter reaches the lower esophageal sphincter, the contractility of the sphincter is measured to assess its function.
Step 4: Measurement of Mid-Esophagus - The catheter is then retracted to the mid-esophagus, where the patient is given water to sip. This allows for the measurement of muscle contractility in the mid-esophagus.
Step 5: Administration of Stimulant - In CPT® Code 91011, mecholyl or a similar stimulant is administered to evaluate the esophageal response. This cholinergic agent enhances secretions and smooth muscle contractions, providing additional data on esophageal motility.
Step 6: Catheter Withdrawal - After the necessary measurements are taken, the catheter is withdrawn from the esophagus.
Step 7: Review of Results - The physician reviews the test results and provides a comprehensive written evaluation of the esophageal motility findings.

3. Post-Procedure

Post-procedure care for the esophageal motility study (CPT® Code 91011) typically involves monitoring the patient for any immediate adverse reactions to the stimulant administered. Patients may experience temporary discomfort or a sensation of fullness in the throat following the procedure. It is important for the physician to review the results with the patient, discussing any findings and potential next steps for treatment or further evaluation. Patients are generally advised to resume normal activities unless otherwise directed by their healthcare provider.

Short Descr	ESOPHAGUS MOTILITY STUDY
Medium Descr	ESOPHGL MOTILITY STD MECHOLYL/SIMILAR STIMULANT
Long Descr	Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; with mecholyl or similar stimulant
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
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	Ancillary Services
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	97 - Other gastrointestinal diagnostic procedures