Radiology Coding Alert

Question: I need to code for 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?

Georgia Subscriber

Answer: If the physician doesn't document the type of dysphagia the patient has, you should opt for 787.20 (Dysphagia, unspecified).

The other codes in the 787.2x range describe impairment of specific anatomic areas, so you shouldn't choose one of those codes without supporting documentation.

For example: The code for oropharyngeal dysphagia (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."