Pulmonology Coding Alert

Question: My pulmonologist diagnosed a patient with nasopharyngeal carcinoma status post radiation and chemo with subsequent dysphagia and nasopharyngeal stenosis. Can I code the dysphagia as oropharyngeal phase when the note does not specifically mention the condition as such?Answer: If the pulmonologist doesn't specify in her notes the type of dysphagia the patient has, you should opt for dysphagia unspecified or 787.20. ICD-9 787.22 (Dysphagia; oropharyngeal phase) represents "impaired structure/ physiology of tongue base and pharyngeal walls," according to the American Speech-Language-Hearing Association (ASHA). On the other hand, 787.21 (... oral phase) describes "impaired structure/physiology of palate, tongue, lips, cheeks", while 787.23 (... pharyngeal phase) represents "impaired structure/ physiology of pharynx and larynx."ICD-9 787.22 has better specificity of the affected swallowing disorder phase. For instance, a patient with oral dysphagia has difficulty in the voluntary transfer of food from the mouth to the pharyx. In pharyngeal dysphagia, the patient has [...]