# Modified Barium Swallows



## michaelrcpc (Apr 28, 2010)

I am currently reviewing MBS reports and have a few questions I'm looking for some expertise on.

1.  What is required for codes 70371 and 74230?  Is a record of the study that can reviewed post-procedure required (cine films or video tape)  Is a Speech pathologist required?

2. What exactly does the radiologist need to document?

3.  What is the appropriate coding in vide/cine are not available for post. procedure review?  74220?

Thanks


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## kmhall (May 4, 2010)

*Modified Barium Swallow*

This is not my area of expertise but I think I have some information that will help.  Here goes.

Ingenix Coder's Desk Reference for Procedures states:

70371 - A radiologic study is performed for pharyngeal and speech evaluation.  Cineradiography, or video recording, is employed, as the physiologic event of speech and swallowing occur too rapidly for normal fluoroscopic viewing.  High-speed frame rates are used to evaluate speech and swallowing, and later reviewed and interpreted by the radiologist.

74230 - 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 and while he/she swallows the various test items, and the fluoroscopic image is recorded on videotape for later review.  This procedure includes observation of 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.

74220 - Films are taken of the esophagus, which is the muscular tube, about nine inches long, that carries swallowed foods and liquids from the pharynx to the stomach.  Films are taken both before and after introduction of a contrast material consisting of barium sulfate.  Hence, this study is also commonly referred to as a "barium swallow".  Structural abnormalities of the esophagus and vessels, such as esophageal varices, may be diagnosed by use of this study.  There are no number or type of views associated with this procedure.

Hope this helps.


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