Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: I know there is mixed discussion about reports with barium swallows. In some instances this is coded with 74230 and other times with 74220. Which is correct? New Mexico Subscriber Answer: CPT Codes 74230 (Swallowing function, with cineradiology/video) assesses how the oral cavity, pharynx and the upper esophagus perform in patients with signs and/or symptoms suggestive of swallowing problems.
It is most often performed on patients who have had 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 who have Parkinson's disease (332.0-332.1). Other diagnosis codes that may be used to justify 74230 include 150.0-150.9 (Malignant neoplasm of esophagus), 235.6 (Neoplasm of uncertain behavior of larynx), and 507.0 (Pneumonitis due to solids and liquids, due to inhalation of food or vomitus), or various impairments and/or injuries of cranial nerves or the recurrent laryngeal nerve.
During the exam, videofluoroscopy is used to view the function of the mouth, pharynx (which closes as food progresses through it during the swallow) and cervical esophagus. Graduated amounts of thin liquids and, eventually, solid foods may be given to patients, and their ability to swallow each is measured. The fluoroscopic study is recorded on video or digital for in-depth analysis. This study does not necessarily include an evaluation of the entire esophagus, but it may. This service should be differentiated from 74210, which is also a study of the pharynx and/or cervical esophagus. This latter study does not include the remainder of the esophagus and also does not include a dynamic study that is captured by either video or digital sequential images.
Code 74220 (Radiologic examination; esophagus) is also conducted during a barium-swallowing test and describes a fluoroscopic examination of the entire esophagus. However, this test does not include videotaping or any dynamic evaluation of the swallowing mechanism. This exam includes hard-copy images of the entire esophagus from the mouth to the stomach.
Although this study may be used to diagnose many of the same conditions as 74230, the dynamic portion of the study is not included in this examination. And this study is used to evaluate intrinsic or extrinsic lesions that may affect the esophagus including neoplasms, vascular abnormalities, or dysfunction at the gastroesophageal junction. Only one of these two (74230 and 74220) codes is usually reported for the study, depending on the nature of the evaluation. Codes 74210 and 74230 are not reported in conjunction with one another.
