Radiology Coding Alert

The pharyngeal evaluation code might get you 63 percent more money, but it could also bring big trouble

If you use CPT 74230 and 70371 interchangeably for swallowing disorders, you're over-looking the best place to find the correct code: your physician's documentation.

Link 74230 to Swallowing Disorders

Speech-language pathologists perform swallowing studies to document how a patient's oral cavity, pharynx and upper esophagus perform when he swallows. "We perform the modified barium swallow study for patients with signs of oropharyngeal dysphagia," says Juli Trautman, MS, CCC/SLP, a clinical speech pathologist at Duke University Medical Center in Durham, N.C.

The speech-language pathologist administers foods and liquids of varying consistencies, Trautman says, while the radiologist administers fluoroscopy. You should report 74230 (Swallowing function, with cineradiography/videoradiography) for this service.

The speech-language pathologist reports a code from the 92610-92612 series, or 92614 (Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording), says Cindy Pack, a consultant with Coder CPC Consultants, a healthcare reimbursement consulting firm in upstate New York.

Patients who require these tests, also referred to as video fluoroscopic swallow studies, are often status-post a stroke and experiencing dysphagia (438.82). Other diagnosis codes that may justify this procedure include 150.0-150.9 (Malignant neoplasm of esophagus), 235.6 (Neoplasm of uncertain behavior of larynx), ICD-9 787.2 (Dysphagia) and 507.0 (Pneumonitis due to solids and liquids; due to inhalation of food or vomitus). Medicare carriers' policies vary, however, so always confirm your payers' guidelines before you perform swallowing studies. 

You cannot separately report additional fluoroscopy codes, such as 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]), because 74230 includes all fluoroscopy services during the study.

Look to 70371 for Speech or Pharyngeal Evaluation

If the radiologist documents a fluoroscopy-aided speech evaluation, you should report 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording). Like the barium swallow study, this procedure assesses mouth and throat function, but, more specifically, it allows the speech-language pathologist to record how the patient's tongue, palate and other soft tissues function. Coders should never substitute 70371 when 74230 is more accurate, regardless of the fees associated with these codes.

If you interchange the two codes, you could put your practice at risk. Because payers reimburse about 63 percent more for 70371, insurers are on the lookout for practices that "upcode" their procedures from 74230.

If the radiologist's documentation is too vague to determine whether she performed a pharyngeal evaluation or a swallowing study, you should always double-check with her. Although some radiology coders might try to select the correct CPT code based on the diagnoses listed in the report, that isn't always an accurate guide. Some conditions, such as 784.5 (Other speech disturbance), are specific to pharyngeal/speech evaluations.

But other diagnoses overlap between both procedures and won't help a coder select the appropriate code. Stroke and throat cancer, for example, are payable diagnoses for both procedures.