Otolaryngology Coding Alert

Question: A patient with carcinoma S/P radiation and chemo has subsequent dysphagia and stenosis. How do I report the dysphagia as I see many options to report the diagnosis?

New Hampshire Subscriber

Answer: If your surgeon has not specifically mentioned in the documentation the phase of swallowing in which the patient is experiencing the dysphagia then you will have to report an unspecified code to report the diagnosis. In the past, you reported this with 787.20 (Dysphagia, unspecified). Now, with ICD-10, that changes to R13.10 (Dysphagia, unspecified).

Previous code 787.22 (Dysphagia, oropharyngeal phase) represented “impaired structure/physiology of tongue base and pharyngeal walls,” according to the American Speech-Language-Hearing Association (ASHA). In comparison, 787.21 (… oral phase) described “impaired structure/physiology of palate, tongue, lips, cheeks” and 787.23 (…pharyngeal phase) represented “impaired structure/physiology of pharynx and larynx.” Your new diagnosis codes as of 10/1/2015 for these conditions are:

• R13.11 (Dysphagia, oral phase) instead of 787.21
• R13.12 (Dysphagia, oropharyngeal phase) instead of 787.22
• R13.13 (Dysphagia, pharyngeal phase) instead of 787.23.

Dysphagia symptoms significantly vary depending on the affected phase and treatment strategies are specific to the affected phase of swallowing. For instance, a patient with oral dysphagia has difficulty in the voluntary transfer of food from the mouth to the pharynx. In pharyngeal dysphagia, reflexive transfer of food from pharynx to initiate involuntary esophageal phase of swallowing while protecting airway from misdirection of food is difficult.

Other options: The patient may require further testing to identify the affected phase. When your clinician evaluates the patient to assess the dysphagia, you will report 92610 (Evaluation of oral and pharyngeal swallowing function). For videofluoroscopic evaluation, submit 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording). For instance, the evaluations revealed issues such as difficulty with preparation of the bolus, premature loss over back of tongue, penetration into upper laryngeal vestibule and residue in pyriforms with risk of aspiration. In this case, the patient is experiencing dysphagia in the oropharyngeal phase. So, you should assign R13.12 as the associated diagnosis.