Gastroenterology Coding Alert

CPT has a lone code to fit most of dysphagia-related treatment. Find out what.

If you're often calling for help with questions on coding and reimbursement of dysphagia evaluation and treatment, you should worry no more. The following frequently asked questions (FAQs) should enlighten you on your most common concerns.

1. What ICD-9 Codes Should You Use To Diagnose Dysphagia?

You will find six ICD-9 codes that are commonly used by practices to provide an appropriate dysphagia diagnosis:

• 787.20 -- Dysphagia, unspecified
• 787.21 -- Dysphagia, oral phase
• 787.22 -- Dysphagia, oropharyngeal phase
• 787.23 -- Dysphagia, pharyngeal phase
• 787.24 -- Dysphagia, pharyngoesophageal phase
• 787.29 -- Other dysphagia

Gastroenterologists should use 438.82 (Dysphagia cerebrovascular disease) coupled with an additional code from the 787.20��"787.29 series for dysphagia due to the late effects of cerebrovascular disease. Using the combined ICD-9 codes should identify the specific type of dysphagia, if appropriate.

"Unspecified" and "Other" Serve Their Purpose

When you're coding 787.20, remember that its descriptor means that the information in the medical record is insufficient to assign a more specific diagnosis other than "dysphagia." For instance, a physician refers a patient to a speech language pathologist (SLP) for a swallowing assessment. The referral would report the diagnosis using 787.20; the SLP would then provide a more definitive diagnosis (787.21-787.24). The not-elsewhere-classified dysphagia code 787.29 applies for a specific dysphagia disorder that has not been identified in the current ICD-9, for example, cervical dysphagia and neurogenic dysphagia.

2. What CPT Codes Should You Use for Dysphagia-related Services?

Typically, SLPs would use six ICD-9 codes to report services related to dysphagia. These are:

• 92526 -- Treatment of swallowing dysfunction and/or oral function for feeding
• 92610 -- Evaluation of oral & pharyngeal swallowing function
• 92611 -- Motion fluoroscopic evaluation of swallowing function by cine or video recording (MBS)
• 92612 -- Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording (FEES)
• 92614 -- Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording
• 92616 -- Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing (FEEST) by cine or video recording.

However, for most gastroenterology practices 92526 (Treatment of swallowing dysfunction and/or oral function for feeding) is the lone choice when reporting treatments associated with dysphagia related to any of the upper throat mechanics, according to the National Government Services LCD.

Additionally, the Correct Coding Initiative (CCI) prohibits combining 92526 with other CPTs when the focus of the treatment is for swallowing. For instance, you should never use the 97xxx series of codes when billing for dysphagia treatment.

Other prohibited combo with 92526 includes:

• 92511 -- Nasopharyngoscopy
• 92520 -- Laryngeal function studies
• 97032 -- Electrical stimulation
• 97110 -- Therapeutic exercises
• 97112 -- Neuromuscular reeducation
• 97150 -- Group therapeutic procedures
• 97530 -- Therapeutic activities
• 97532 -- Cognitive skills development.

Profit: The Medicare rate for dysphagia treatment is about $102 (based on RVU of 2.77 and a conversion factor of $36.8729).

3. What Restrictions Has CCI Imposed on Dysphagia Treatment Codes?

CCI edits on dysphagia-related services prohibits billing the codes together or requires using modifier 59 (Distinct procedural service) to indicate that they are distinctly separate procedures.

Example: 92612 may not be reported on the same day as 92614. However, CCI edits allow billing 92610 on the same day as 92611, provided you apply modifier 59. Check out some of the other dysphagia-related pairings included in CCI edits: