Oncology & Hematology Coding Alert

Question: What is a modified barium swallow? Is there a specific code for reporting services of a modified barium swallow? Can we also report esophageal studies and swallowing function in addition to barium swallow?

Florida Subscriber

Answer: For a modified barium swallow, you submit code 74230 (Swallowing function, with cineradiography/videoradiography) when the procedure is primarily performed by your physician for evaluating the patient’s swallowing function.

What is modified barium swallow? When performing this study, your physician will aim to evaluate the oropharynx, hypopharynx, and upper esophagus. The patient receives various amounts of barium to swallow in several different consistencies and following this, your physician will obtain a series of images, both at normal speed and in slow motion.

Watch the bundle: Both esophagus studies 74210 (Radiologic examination; pharynx and/or cervical esophagus) and 74220 (Radiologic examination; esophagus) are bundled into 74230, so you cannot bill 74220 and 74230 in addition to the swallowing function study.

Your physician may, however, evaluate the swallowing function in addition to performing an upper GI radiological examination. Thus, you can report code 74230 in conjunction with an upper GI series, 74240 (Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB) - 74249 (Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through).