CPT® Code 91013

Add-On Code

1. Indications

The esophageal motility study (CPT® Code 91013) is indicated for patients experiencing specific symptoms or conditions that warrant further investigation of esophageal function. The following indications are explicitly associated with this procedure:

• Swallowing Difficulties Patients who have trouble swallowing (dysphagia) may require this study to determine the underlying cause of their symptoms.
• Non-Cardiac Chest Pain Individuals presenting with chest pain that is not related to cardiac issues may undergo this study to assess esophageal motility and identify potential esophageal disorders.
• Esophageal Achalasia This condition, characterized by the failure of the lower esophageal sphincter to relax and uncoordinated contractions of the esophagus, is commonly diagnosed through this procedure.

2. Procedure

The esophageal motility study (CPT® Code 91013) involves several key procedural steps that are essential for accurately assessing esophageal function. The following steps outline the process:

• Step 1: Preparation The patient is prepared for the procedure, which may include numbing one of the nostrils with lidocaine to facilitate the insertion of the catheter.
• 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 advanced to the lower esophageal sphincter, where the contractility of the sphincter is measured. This step is crucial for evaluating the function of the sphincter.
• Step 4: Mid-Esophageal Measurement The catheter is then retracted to the middle of the pharynx, and the patient is given water to sip. The muscle contractility of the mid-esophagus is measured and displayed on the manometry monitor as a two-dimensional (2D) graph.
• Step 5: Stimulation or Perfusion In the context of CPT® Code 91013, a stimulant such as Mecholyl is administered, or an acid perfusion study is performed. Mecholyl, a cholinergic agent, increases secretions and smooth muscle contractions, allowing for further evaluation of esophageal motility.
• Step 6: Acid Perfusion Alternatively, a mild hydrochloric acid solution may be instilled through the esophageal catheter, followed by a salt water solution. The patient is asked to report any discomfort or pain associated with the acid instillation.
• Step 7: Data Review Enhanced 2D images of the esophageal contractions are displayed on the manometry monitor, and the physician reviews the test results to provide a comprehensive written evaluation of the findings.

3. Post-Procedure

After the completion of the esophageal motility study (CPT® Code 91013), the patient may be monitored for any immediate reactions to the procedure, particularly in response to the stimulant or acid perfusion. It is important for the physician to review the results and provide a detailed report, which will guide further clinical management. Patients may be advised to resume normal activities unless otherwise directed, and any specific post-procedure care instructions will be provided based on the individual patient's condition and the findings of the study. Follow-up appointments may be scheduled to discuss the results and potential treatment options based on the evaluation of esophageal motility.