# 74230?? - I cade for the Radiologist



## Lynda Wetter (Jun 20, 2011)

Can anyone help..
I cade for the Radiologist and I am courious to know of any requirements fro billing CPT 74230??
Any info on the cpt would be great!!!

Thanks In Advance.


----------



## BRBS  (Jun 22, 2011)

This study is also known as a modified barium swallow. The patient is seated and positioned upright or in a semi-reclining position. Foods and liquids of different quantities and textures are soaked in or mixed with barium and given to the patient for the study. The patient is fluoroscoped while he/she swallows the various test items, and the fluoroscopic image is recorded on videotape for later review. The radiologist observes the food/liquid while in the mouth and during chewing, the tongue's mobility, movement of the hyoid bone and larynx, closing of the larynx and contraction of the pharynx, the extent of the pharyngoesophageal opening, and any aspiration or penetration of the swallowed bolus into the upper airway. Muscle strength may also be measured.

The speech-language pathologist administers foods and liquids of varying consistencies, while the radiologist administers fluoroscopy. 

If the radiologist documents a fluoroscopy-aided speech evaluation, you should report 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording). Like the barium swallow study, this procedure assesses mouth and throat function, but, more specifically, it allows the speech-language pathologist to record how the patient's tongue, palate and other soft tissues function. Coders should never substitute 70371 when 74230 is more accurate, regardless of the fees associated with these codes.


----------



## Lynda Wetter (Jun 22, 2011)

So in the example below ..billing for the radiologist ....74230would be appropriate??


Modified barium swallow.  

Findings: Fluoroscopic assistance was provided for the department of 
speech pathology.  

There is delayed initiation of swallowing. The pudding and solid 
consistencies are well tolerated. There is penetration to the vocal 
cords with thin liquids. There is occasional mild penetration with 
with nectar consistencies.  

Impression: 
1. Penetration with thin and nectar consistencies as above.  
2. Please see the separate dedicated speech pathology report for 
further details.


----------



## BRBS  (Jun 22, 2011)

absolutely 74230 - 26.


----------



## srinivas r sajja (Jun 23, 2011)

cineradiography or videoradography or rapid flow fluoro should be documented to report 74230


----------



## jbaird (Jun 23, 2011)

I think this is a plain barium swallow (74220) because cine/videoradiography is not stated.


----------



## Lynda Wetter (Jun 23, 2011)

so cine/videoradiography must be mentioned in order to charge for 74230? Does anyone have any reference websites or documentation to help me support that....I think CPT discriptor should be enough??


----------



## BRBS  (Jun 23, 2011)

The basic difference between CPT 74220 and 74230 is the dynamic evaluation of the swallowing mechanism is not included in 74220. 

74220 is only a fluoroscopic evaluation of esophagus.

The provider may not always dictate the cineradiology/video analysis in the body of the report. By looking into the key words we may be able to find out. Such as,

There is delayed initiation of swallowing. The pudding and solid consistencies are well tolerated. There is penetration to the vocal cords with thin liquids. There is occasional mild penetration with with nectar consistencies.

These key terms correspond to the dynamic evaluation done by the rad. Also the header by the rad and also the assistance to the speech path makes me lean towards 74230.

Below is a doc I copied from the Super coder forum.

During MBS, video fluoroscopy is used to view the function of the mouth, pharynx (which closes as food progresses through it during the swallow) and cervical esophagus. 

Graduated amounts of thin liquids and, eventually, solid foods may be given to patients, and their ability to swallow each is measured. The fluoroscopic study is recorded on video or digital for in-depth analysis. 

This study does not necessarily include an evaluation of the entire esophagus, but it may. 

This service should be differentiated from 74210, which is also a study of the pharynx and/or cervical esophagus. This latter study does not include the remainder of the esophagus and also does not include a dynamic study that is captured by either video or digital sequential images.

Code 74220 (Radiologic examination; esophagus) is also conducted during a barium-swallowing test and describes a fluoroscopic examination of the entire esophagus. However, this test does not include videotaping or any dynamic evaluation of the swallowing mechanism. This exam includes hard-copy images of the entire esophagus from the mouth to the stomach. 

Although this study may be used to diagnose many of the same conditions as 74230, the dynamic portion of the study is not included in this examination. And this study is used to evaluate intrinsic or extrinsic lesions that may affect the esophagus including neoplasms, vascular abnormalities, or dysfunction at the gastroesophageal junction


----------



## tmhgotjss (Jun 29, 2012)

*Piggybacking onto CPT 74230--6/23/12*

I have a question regarding CPT 74230:  If the physician does not state in his/her documentation that the patient has "dysphagia", but during the exam patient has aspiration with thin liquid, I cannot code 507.0-Aspiration Pneumonitis, but can I code unspecified dysphagia 787.20, even though the term "dysphagia" is not documented in the report?  For example:  How would you code this procedure:

Modified Barium Swallow:
Indication: Feeding difficulty and mismanagement- 783.3
This study performed under supervision of speech pathologist. Radiologist has provided fluroscopy examination an interpretation.
On the upright AP view of chest obtained prior to modified barium swallow, cardiac size appears to be normal.  Pulmonary vascularity is not engorged.  there is no evidence of confluent infiltrates in lungs.  The patient was given to swallow thin liquid, liquid of nectar consistency, liguid of honey consistency, applesauce and cookie.  With first few swallows of thin liquid there has been evidence of mild to moderate penetration, without aspiration. But at the end of the study again, the patient has been given to swallow thin liquid.  At this time _there has been aspiration into laryngotracheal airways with mild cough reflex.  _With swallowing of liquid of nectar, and liguid of honey consistencies, applesauce, and cookie there has been no evidence of penetration or aspiration into larynx.

Impression:
The patient has aspirated thin liquid. Thin liquid food items .should be avoided.

Thanks for any advice.

---Dysphagia Bewildered









BRBS  said:


> The basic difference between CPT 74220 and 74230 is the dynamic evaluation of the swallowing mechanism is not included in 74220.
> 
> 74220 is only a fluoroscopic evaluation of esophagus.
> 
> ...


----------



## kml1764 (Jul 1, 2012)

BRBS  said:


> If the radiologist documents a fluoroscopy-aided speech evaluation, *you should report 70371* (Complex dynamic pharyngeal and speech evaluation by cine or video recording). Like the barium swallow study, this procedure assesses mouth and throat function, but, more specifically, it allows the speech-language pathologist to record how the patient's tongue, palate and other soft tissues function.* Coders should never substitute 70371 when 74230 is more accurate*, regardless of the fees associated with these codes.



I'm sorry, but that is confusing.


----------



## Lynda Wetter (Jul 3, 2012)

tmhgotjss said:


> i have a question regarding cpt 74230:  If the physician does not state in his/her documentation that the patient has "dysphagia", but during the exam patient has aspiration with thin liquid, i cannot code 507.0-aspiration pneumonitis, but can i code unspecified dysphagia 787.20, even though the term "dysphagia" is not documented in the report?  For example:  How would you code this procedure:
> 
> Modified barium swallow:
> Indication: Feeding difficulty and mismanagement- 783.3
> ...




i would either go with your symptoms of feeding difficulties or follow the icd9 codes of aspiration to the 933.x series


----------



## deut649 (Aug 7, 2014)

*Medicare denial*

So why if I bill 74230 26 with an diagnosis of dyphagia is Medicare denying the claim.  Actually all of my swallow tests are denied.  checked the LCD and every thing looks good. they denied stating lacks information for ajudiacation. perhaps notes need to be sent for each one?


----------



## Lynda Wetter (Aug 7, 2014)

From what I remember from my radiology days, dysphagia requires a second diagnosis that is on the LCD approved list. 
I remember cough was a asecondary code so if the patient had difficulty swallowing and a cough both would have to be reported.


----------

