Home Health ICD-9/ICD-10 Alert

More specificity required for speech therapy.

When you code for a patient with stroke-related or other dysphagia, stopping too soon can lead to inadequate treatment, increased medical review and more payment denials.

The bottom line: You can no longer use the code for dysphagia--787.2--you used before Oct. 1, because it now requires a fifth digit.

Beginning Oct. 1 home care coders must use the new ICD-9-CM codes the Centers for Medicare & Medicaid Services released in June. Among these codes are six new dysphagia codes. These additional codes will indicate the phase of swallowing the dysphagia affects, says coding consultant Tricia Twombly, BSN, RN, HCS-D, with Foundation Management Services in Denton, TX.

Added complexity: As of Oct. 1, the late effect CVA with dysphagia code--438.82--requires you to add the dysphagia code to specify the phase of swallowing affected, warns Jun Mapili, PT, MAEd coding supervisor with Global Home Care in Troy, MI. When these two codes occur together, the patient will accrue case mix points for added reimbursement under the new PPS payment rules, he adds.

The basics: Dysphagia is defined as difficulty swallowing, Mapili explains. Swallowing allows the body to securely transport food from the mouth to the stomach.

In this amazingly complex process, "conscious and unconscious events [are] carried out by over 40 pairs of muscles that have to be finely coordinated," Mapili says. Countless diseases affect this fundamental process, he adds.

Code Dysphagia After Speech Therapy Evaluation

The speech therapist can select the correct code after completing the swallowing assessment, says Lemmietta McNeilly, PhD, CCC-SLP, ASHA Fellow with the Rockville, MD-based American Speech-Language-Hearing Association, in a reminder to association members. The updated dysphagia codes are:

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