Radiology Coding Alert

Swallowing studies are usually conducted for two reasons: to assess why patients have difficulty ingesting food and drink, and to investigate functional and structural factors contributing to speech pathologies. Because the services share several characteristics, coders often confuse the codes for them 74230 and 70371.

"Nonetheless, these services are very different and are conducted for very different reasons," notes Deepa Malhotra, CPC, director of coding at Health Care Information Services, a physician billing company in Willowbrook, Ill. "Coders need to be able to read the radiologist's notes and determine what prompted the study to assign the correct code."

The service reported most often by radiologists is CPT 74230 (Swallowing function, with cineradiography/videoradi-ography), often referred to as a classic modified barium swallow, according to Renee Deville, a radiology coder with Physician Management Consultants in Monroe, La. "The study allows the physician to create images of a patient's mouth and throat while swallowing," she says. "The doctor can measure physiological function and observe the rate at which various substances can be swallowed."

A swallowing-function study can be ordered for several conditions, Deville says. Common uses include patients with the effects of a stroke (436, Acute, but ill-defined, cerebrovascular disease; 438.11, Late effects of cerebrovascular disease, aphasia; 438.12, Late effects of cerebrovascular disease, dysphasia) or with difficulties from Parkinson's disease (332.0-332.1). In addition, swallowing studies may be performed for patients diagnosed with malignant neoplasms of the esophagus (e.g., 150.0-150.9), neoplasms of the larynx (e.g., 235.6) and pneumonia due to inhalation of food or vomitus (e.g., 507.0). Increasingly, she adds, they are conducted in children who have feeding problems (ICD-9 783.3 ), and they are especially valuable when used to evaluate patients who are at risk for aspirating food into their airway (trachea and lungs) while eating.

The radiologist uses videofluoroscopy to view the function of the oral cavity, pharynx (which closes as food progresses through it during the swallow) and cervical esophagus. During the exam, patients are given graduated amounts of thin liquids and solid foods. Deville notes that the radiologist conducts a fluorographic study to measure the patient's ability to swallow each substance and records the data on video for in-depth analysis.

A speech pathologist is typically involved in the study. The procedural component reflecting his or her services would be assigned 92525 (Evaluation of swallowing and oral function for feeding), while the radiologist performing the fluoroscopy would report 74230.

According to Malhotra, 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording) describes the study of the movements of tissues in the mouth and throat and is most often used for speech evaluation. The patient repeats a proscribed set of words and sounds, and fluoroscopy records how the tongue, palate and other soft tissues in the mouth function. These tests are often conducted on pediatric patients with delayed speech development (e.g., 784.5, Other speech disturbance [dysarthria, dysphasia, slurred speech]).

Because of the potential for confusion between 74230 and 70371, the radiologist's dictation is vital. "The coder needs to know exactly what was studied and recorded to be able to assign the appropriate code," Malhotra points out. "It should be clear that 74230 is used for swallowing disorders, while 70371 is used for speech evaluation."

Note: A third code describes a similar study, although it is rarely used: 70370 (Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique) is assigned for radiologic exams using fluoroscopy and/or magnification techniques. It does not, however, include the dynamic elements of the speech evaluation code and does not include videotaping.