Otolaryngology Coding Alert

Question: Our office is considering fiberoptic endoscopic evaluation of swallowing (FEES). A speech pathologist would come to the office to help. How do we code the report so we and the speech therapist get reimbursed?

Texas Subscriber

Answer: For both the physician and the speech pathologist to be billable, the ENT must be closely involved in the procedure. You-ll use either 92612 (Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording) or 92616 (Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording), but only if the physician evaluates the patient and interprets the report.

Caution: You cannot report 92612 and 92616 if the physician merely supervises a technician who conducts the FEES or FEEST evaluation.

Watch for "incident to": If a speech pathologist provides these services, you must report the codes incident to the physician's services. Supervision and plan of care by the physician is a must: To report 92612 and 92616 incident to, specially trained and credentialed speech pathologists who perform these services must do so under the direct supervision of a physician (who designs the plan of care) to receive Medicare reimbursement.

Doctor in the house: The physician must be in the office suite and immediately available to provide assistance and direction throughout the time the auxiliary personnel are performing services. Phone contact doesn't count.

Specific trumps general: You should not report 92520 (Laryngeal function studies [i.e., aerodynamic testing and acoustic testing]) in addition to 92612 or 92616. The Correct Coding Initiative considers 92520 included within the FEES or FEEST evaluation.