Radiology Coding Alert

Check services of speech lingual pathologist, and beware of services that are bundled.

In the last issue of Radiology Coding Alert Vol17n10, you attempted a quiz on reporting modified barium swallow. Here are answers to the quiz to help you assess your understanding for codes 74230 and 92611.

Match 74230 to Modified Barium Swallow

Answer 1: The correct answer is a, Nasopharynx.

The service described by 74230 (Swallowing function, with cineradiography/videoradiography) is primarily performed by your physician for evaluating the patient’s swallowing function. This study is also known as a modified barium swallow.

When performing this study, your physician will aim to evaluate the oropharynx, hypopharynx, and upper esophagus. The patient receives various amounts of barium to swallow in several different consistencies and following this, your physician will obtain a series of images, both at normal speed and in slow motion.

Look for Documentation of Imaging Films

Answer 2: The correct answer is d, All of the above.

If you look at the documentation, you will find 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.

Beware of Bundles for 74230

Answer 3: The correct answer is d, 74220.

Watch for the following bundles when you report barium swallows:

Both esophagus studies 74210 (Radiologic examination; pharynx and/ or cervical esophagus) and 74220 (Radiologic examination; esophagus) are bundled into 74230, so you cannot bill 74220 and 74230 in addition to the swallowing function study.

Your physician may however, evaluate the swallowing function in addition to performing an upper GI radiological examination. Thus, you can report code 74230 in conjunction with an upper GI series, 74240 (Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB) -74249 (Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through).

Watch SLP Role to Prevent 92611 Mishap

Answer 4: The correct answer is b, 92611.

A speech pathologist may participate in the barium swallow but not always.

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.

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 or other qualified health care professional time more than 1 hour, assisting a non-radiologic physician or other qualified health care professional [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

Answer 5: The correct answer is c, 70731.

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.

The physician will ask the patient 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.