Home Health ICD-9/ICD-10 Alert

Question: Our patient has nasopharyngeal carcinoma status post radiation and chemo with subsequent dysphagia and nasopharyngeal stenosis. Can I code the dysphagia as oropharyngeal phase when the note does not specifically mention the condition as such?

Answer:If the documentation doesn't specify the type of dysphagia the patient has, you should opt for dysphagia unspecified or 787.20.

ICD-9 code 787.22 (Dysphagia; oropharyngeal phase) represents "impaired structure/physiology of tongue base and pharyngeal walls," according to the American Speech-Language-Hearing Association. Dysphagia code 787.21 (... oral phase) describes "impaired structure/physiology of palate, tongue, lips, cheeks", while 787.23 (... pharyngeal phase) is used to indicate "impaired structure/physiology of pharynx and larynx."

A patient with oral dysphagia (787.21) has difficulty in the voluntary transfer of food from the mouth to the pharynx. In pharyngeal dysphagia, the patient has difficulty in reflexive transfer of food from the pharynx to initiate the involuntary esophageal phase of swallowing while protecting the airway from misdirection of food. In this case, the patient usually undergoes further testing to identify the affected phase.

If the test reveals difficulty with preparation of the bolus, premature loss over the back of tongue, some penetration into the upper laryngeal vestibule and residue in pyriforms with risk of aspiration, then the physician or speech language pathologist would diagnose oropharyngeal dysphagia (787.22).