CPT® Code 91012

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1. Indications

The esophageal motility study with acid perfusion studies (CPT® Code 91012) is indicated for the following conditions:

• Swallowing Difficulties This procedure is performed to investigate the underlying causes of dysphagia, which is the medical term for difficulty swallowing.
• Non-Cardiac Chest Pain It is utilized to evaluate chest pain that is not related to cardiac issues, helping to determine if esophageal dysfunction is the cause.
• Esophageal Achalasia The study is particularly useful in diagnosing esophageal achalasia, a condition characterized by the failure of the lower esophageal sphincter to relax, leading to obstruction.
• Esophageal Motility Disorders It helps in assessing various motility disorders of the esophagus, providing insights into abnormal muscle contractions.

2. Procedure

The procedure for CPT® Code 91012 involves several detailed steps to ensure accurate assessment of esophageal motility and the effects of acid perfusion:

• Step 1: Preparation The patient is prepared for the procedure, which includes numbing one of the nostrils 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 advancement of the catheter.
• Step 3: Measurement of Lower Esophageal Sphincter The catheter is positioned at the lower esophageal sphincter, where 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, and the patient is given water to sip. This allows for the measurement of muscle contractility in the mid-esophagus.
• Step 5: Acid Perfusion Study Following the motility assessment, acid perfusion studies are conducted. A mild hydrochloric acid solution is instilled through the esophageal catheter into the esophagus, followed by a saline solution. The patient is asked to report any discomfort or pain experienced during the acid instillation.
• Step 6: Evaluation After the completion of the study, the physician reviews the test results and provides a written evaluation of the esophageal motility, summarizing the findings and any abnormalities detected during the procedure.

3. Post-Procedure

After the esophageal motility study with acid perfusion, patients may experience some temporary discomfort due to the catheterization and the acid instillation. It is important for patients to follow any post-procedure instructions provided by the healthcare provider, which may include dietary recommendations or monitoring for any unusual symptoms. The physician will typically discuss the results of the study with the patient during a follow-up appointment, where further management or treatment options may be considered based on the findings.