Primary Care Coding Alert

Question: If a provider documents different phases of dysphagia, do you code each phase separately? For example, if the provider documents oral dysphagia and pharyngeal dysphagia, do you provide codes for both? And how do you code for odynophagia?

AAPC Forum Participant

Answer: The process of swallowing occurs in three phases:

1. Oral phase – food enters the mouth and is broken down by saliva and chewing into a form that the tongue can move to the back of the mouth.
2. Pharyngeal phase – food passes through the throat, or pharynx.
3. Esophageal phase – food passes through the esophagus.

Dysphagia, or difficulty swallowing, can occur at any of these phases, which roughly correspond to these four ICD-10 codes:

• R13.11 (Dysphagia, oral phase)
• R13.12 (Dysphagia, oropharyngeal phase)
• R13.13 (Dysphagia, pharyngeal phase)
• R13.14 (Dysphagia, pharyngoesophageal phase)

There are no guidelines or notes to tell you whether coding one condition precludes coding another, so as there are separate codes for each phase, you should code conditions separately according to your provider’s documentation.

Code this first: There is a note accompanying the dysphagia codes telling you to code first any cerebrovascular disease for which dysphagia is a sequela, when appropriate, using final characters 91 with the applicable I69.- (Sequelae of cerebrovascular disease) code. So, you would code a patient suffering from dysphagia after a stroke with I69.391 (Dysphagia following cerebral infarction), adding the applicable R13.- code as a secondary diagnosis to describe the specific form of dysphagia.

Odynophagia is a different condition that describes pain while swallowing. To code it, you would use R13.10 (Dysphagia, unspecified).