Otolaryngology Coding Alert

The Health Care Financing Administration (HCFA) has proposed two new codes that would be used by otolaryngologists who perform fiberoptic endoscoping evaluation of swallowing (FEES). In the Nov. 1, 2000, Federal Register, HCFA introduced the codes, saying they will replace the more general CPT 92525 (evaluation of swallowing and oral function for feeding).

According to HCFA, the new codes have been introduced by Medicare carriers, who requested the more precise coding to improve claims review for evaluation of dysphagia.

Nevertheless, because HCFA will continue to leave coverage and reimbursement decisions to local Medicare carriers and will not mandate this service at a national level, the addition of these codes will likely do little to end coverage policy differences among Medicare carriers.

The addition of the codes may make it easier for otolaryngology coders to bill for these services, however, because the new codes specifically describe FEES and FEEST (fiberoptic endoscopic evaluation of swallowing with sensory testing) services.

The two codes are:

G0193 endoscopy study of swallowing function, often referred to as fiberoptic endoscopic evaluation of swallowing (FEES);

G0194 sensory testing during endoscoping study of swallowing, often referred to as FEEST.

According to HCFA, G0194 should be treated as an add-on code to G0193. In other words, if the otolaryngologist (usually in conjunction with a speech pathologist) performs sensory testing during a FEES study, the session should be billed as follows: G0193, G0194.

Presumably, as an add-on code, the multiple procedure rule does not apply to G0194 because the fee for this service is already reduced. Modifier -51 (multiple procedures) should not be attached to the G0194.

With the introduction of the new G codes, HCFA says that 31575 (laryngoscopy, flexible fiberoptic; diagnostic) and 31579 (laryngoscopy, flexible or rigid fiberoptic, with stroboscopy) should not be used. These codes were frequently used to describe the otolaryngologists portion of the service.

If the new G codes are accepted by local carriers, coding these procedures may become greatly simplified. Just after introducing the codes, however, HCFA stated that coverage of the services remains at the discretion of the contractor processing the Medicare claim, who also has the authority to price the service.

Swallowing studies are typically performed on patients who have been intubated for some time and have trouble eating. Barium studies are the most common way to evaluate swallowing ability. A more advanced and increasingly common method is video fluoroscopy, which allows video recording of a patient swallowing several different substances. Either procedure is usually performed by a radiologist in conjunction with a speech pathologist, and often is not billed by otolaryngologists.

Note: HCFA also introduced two new G codes to cover the speech pathologists role in these two swallowing evaluations: G0195 (clinical evaluation of swallowing function) and G0196 (evaluation of swallowing involving swallowing of radio-opaque materials).

When the patient cannot tolerate these radiological studies, the FEES study may be conducted instead, with an otolaryngologist performing a laryngoscopy while a speech pathologist does the swallowing evaluation. This test will provide information on the patients ability to protect the airway and to initiate a prompt swallow without spilling material into the hypopharynx.

The most common reason for a FEES evaluation is difficulty in swallowing (787.2, dysphagia), although some neurologic and other disorders may also lead to a swallowing evaluation and/or treatment.

Obtaining Reimbursement

Now, some carriers accept claims for FEES, whereas others do not cover the procedure or want it billed with an unlisted code, or both. In addition, many Medicare carriers have policies for FEEST, but these policies vary dramatically from carrier to carrier. Some carriers, such as Louisiana Medicare, deny FEES and FEEST coverage entirely. Others, such as HGSA in Pennsylvania, cover the evaluation and scope but want both billed together using one unlisted code.

Because policies have varied so much in the past, coders should call their local carriers to determine (a) if the service is covered (b) if using the new codes is acceptable and (c) how much reimbursement to expect from the carrier, who has been granted complete discretion in this area by HCFA.