Basics of Peroral endoscopic myotomy (POEM) CPT code 43497

Peroral endoscopic myotomy (POEM) is a procedure in which a scope is passed through the
mouth and into the esophagus. Part of the muscle layer of the lower part of the esophagus, the
sphincter, and the upper part of the stomach is removed. POEM has been proposed as a treatment for a variety of esophageal and gastric conditions, including achalasia, diverticula, gastroparesis, and congenital hypertrophic pyloric stenosis. CPT code 43497 is now added for coding POEM exam.

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Description of CPT code 43497

43497  Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM])

The physician performs a transoral lower esophageal myotomy, also known as a peroral endoscopic myotomy or POEM. This procedure is often performed for the treatment of achalasia or spastic esophageal disorders (such as nutcracker esophagus or diffuse esophageal spasm) that have not responded to medical therapy. Prior to the procedure, an IV is inserted into a vein through which anesthesia, fluids, and antibiotics are administered. An arterial line is inserted for pressure monitoring during the procedure. The physician inserts an endoscope through the mouth and into the esophagus, observing the images on a monitor. The first incision is made into the internal lining of the esophagus, through which the endoscope is inserted. The muscle is exposed within the wall of the esophagus; the physician makes an incision (myotomy) in the inner muscle layer near the lower esophageal sphincter. Upon completion of the procedure, the physician repairs the esophageal incision using standard endoscopic clips. The patient is typically admitted for postoperative monitoring and administration of antibiotics.

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Indications of POEM Procedure code 43497

Achalasia is a rare condition in which the lower esophageal sphincter loses inhibitory neural input
making it fail to relax after swallowing. Treatments include Botox injections, laparoscopic Heller
myotomy, and pneumatic dilation.
Gastroparesis is a condition in which the stomach does not empty normally. It is commonly associated with diabetes. Treatments for gastroparesis include medications, better diabetic control, and lifestyle changes such as eating small frequent meals.
Diverticula of the esophagus are pouches that form because the muscles of the esophagus fail to relax after swallowing. This can cause pain, and food can be caught in the diverticula. Serious cases are treated with various types of surgery.