Otolaryngology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: We are billing for flexible endoscopic evaluation of swallowing (Medicare calls it FEEST). Empire Medicare Services (our local Part B carrier) stated in 1998 that this service should be reported using 92525; however, we have received dozens of denials when we use this code. We used G0193 and were told that was also incorrect. What is the correct way to code this service?

New York Subscriber

Answer: Empire Medicare Services is not only a Part B carrier but also a Part A intermediary. Although the Part B carrier has not issued a revised LMRP on this subject since 1999, the Part A intermediary issued revised guidelines that went into effect on Jan. 1, 2001. The new policy states that Medicare no longer uses 92525 (evaluation of swallowing and oral function for feeding) and, instead, lists G0193 (endoscopic study of swallowing function [also fiberoptic endoscopic evaluation of swallowing][FEES]) and G0194 (sensory testing during endoscopic study of swallowing [add on code] referred to as fiberoptic endoscopic evaluation of swallowing with sensory testing][FEEST]).
 
Two important facts should be noted about these services:
 
1. FEEST does not describe the endoscopic swallowing study itself, which is referred to as FEES, and the Part A policy bulletin notes it is reported using G0193. FEEST is an add-on procedure when sensory testing is performed in addition to the FEES study.
 
2. When the G codes were introduced in the Federal Register in November 2000, CMS did not mandate this service at a national level, leaving coverage and reimbursement decisions to local Medicare carriers. It is entirely possible that even though Empire's Part B carrier does not cover the service, its Part A intermediary does cover it. When appealing denials, however, it may be helpful to include the Part A policy bulletin.