Radiology Coding Alert

 Tip 1: Separate speech studies from swallowing studies.

When your radiologist works with a speech-language pathologist to evaluate speech or swallowing function, you have to keep a close eye out both for which procedure they performed and which aspects your radiologist can report. Here's a closer look at the codes you need to know.

Match 74230 to Modified Barium Swallow

The service described by 74230 (Swallowing function, with cineradiography/ videoradiography) "is primarily performed for evaluating the patient's swallowing function," says Cheryl S. Schad, BA Ed, CPC, ACS-RA, PCS, president/CEO of Schad Medical Management in Mullica Hill, N.J.

Term tip: "This study is also known as a modified barium swallow," says Schad.

The swallowing study allows clinicians to evaluate the oropharynx, hypopharynx, and upper esophagus. Staff gives the patient various amounts of barium to swallow in several different consistencies, Schad notes. "Films are obtained at normal speed and in slow motion," allowing evaluation of swallowing, she says.

Documentation may show imaging exams including an anteroposterior (AP) film of the esophagus from neck to diaphragm, right anterior oblique including the neck and thorax, and perhaps a left anterior oblique.

Edit watch: "Both esophagus studies 74210 [Radiologic examination; pharynx and/ or cervical esophagus] and 74220 [... esophagus] are bundled into 74230, so they cannot be billed in addition to the swallowing function study. However, 74230 can be performed and billed in conjunction with an upper GI series, 74240-74249 [Radiological examination, gastrointestinal tract, upper ...]," Schad says.

For the modified barium swallow, "sometimes a speech pathologist participates, but not always," Schad notes.

Medicare recommends a team approach. In discussing SLP services for dysphagia (difficulty swallowing), the Medicare Benefit Policy Manual, chapter 15, section 230.3.D.4., states: "Professional guidelines recommend that the service be provided in a team setting with a physician/NPP who provides supervision of the radiological examination and interpretation of medical conditions revealed in it." Check state guidelines for which provider(s) must be present.

Watch SLP Role to Prevent 92611 Mishap

Ascertaining which providers performed which services is crucial to properly coding the modified barium swallow.

Radiologist: The radiologist providing radiologic supervision and interpretation reports 74230. Code 74230 covers all imaging services during the study, so you should not separately report additional fluoro codes, such as 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]).

SLP: The SLP most likely performs motion fluoroscopic evaluation of swallowing and reports 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording).

Save 70371 for Speech Evals

When documentation shows a modified barium swallow, you want to take care not to report 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording) " a speech evaluation code -- by mistake.

In this fluoroscopy-aided speech evaluation, the goal is to assess how the patient's tongue, palate, and other soft tissues function. Typically a speech pathologist is involved in performing the test, Schad says.

"The patient is asked to repeat specifically chosen words and sounds so that the soft tissues of the mouth and tongue can be evaluated as the patient formulates the words during the speech process," Schad explains.

Apply the Help of This Authoritative Resource

CPT Assistant (December 2004) includes several helpful clues for distinguishing 92611, 74230, and 70371:

92611: This code "indicates a videofluoroscopic evaluation, which incorporates the use of cine (i.e., motion pictures) or video recording to study the oral cavity, larynx, pharynx, and upper esophagus. Various consistencies of ingestants and maneuvers are tested to determine if the patient can protect his or her airway and swallow adequately to maintain nutrition."

74230: "Imaging for code 92611 is reported separately by using code 74230 to identify the radiologic supervision and interpretation."