Radiology Coding Alert

Question: A speech pathologist ordered a modified barium swallow to assess the swallowing function of a patient. The radiologist’s documentation indicates they evaluated the patient’s oropharynx, hypopharynx, and upper esophagus. The only code I find is 74230, which is a radiologic code, not a fluoroscopic one.

Is this the correct code to document the procedure?

New York Subscriber

Answer: For this scenario, there are two services performed that make up the entire procedure. The speech pathologist’s order of the fluoroscopic evaluation of swallowing function, also known as a modified barium swallow, is documented by 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording). You’ll also use 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study) to report the radiologist’s procedure.

You were on the right track with 74230, but the parenthetical note under the descriptor for this code directs you to the rest of the answer:

• “For otorhinolaryngologic services fluoroscopic evaluation of swallowing function, use 92611”

Both the speech pathologist and the radiologist are performing a supervision and interpreting the results of the exam into an official report.