Oral Surgery Coding & Reimbursement Alert
Select Appropriate Dysphagia Code Based on Swallowing Phase
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Question: A patient with carcinoma S/P radiation and chemo has subsequent dysphagia and stenosis. How do I report the dysphagia as I see many options to report the diagnosis?
New Hampshire Subscriber
Answer: If your surgeon has not specifically mentioned in the documentation the phase of swallowing in which the patient is experiencing the dysphagia then you will have to report an unspecified code to report the diagnosis. You report this with 787.20 (Dysphagia, unspecified).
Code 787.22 (Dysphagia, oropharyngeal phase) represents “impaired structure/physiology of tongue base and pharyngeal walls,” according to the American Speech-Language-Hearing Association (ASHA). In comparison, 787.21 (… oral phase) describes “impaired structure/physiology of palate, tongue, lips, cheeks” and 787.23 (…pharyngeal phase) represents “impaired structure/physiology of pharynx and larynx.”
Dysphagia symptoms significantly vary depending on the affected phase and treatment strategies are specific to the affected phase of swallowing. For instance, a patient with oral dysphagia has difficulty in the voluntary transfer of food from the mouth to the pharynx. In pharyngeal dysphagia, reflexive transfer of food from pharynx to initiate involuntary esophageal phase of swallowing while protecting airway from misdirection of food is difficult.
The patient may require further testing to identify the affected phase. When your clinician evaluates the patient to assess the dysphagia, you will have to report 92610 (Evaluation of oral and pharyngeal swallowing function). For videofluoroscopic evaluation, you report 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording). For instance, the evaluations revealed issues such as difficulty with preparation of the bolus, premature loss over back of tongue, penetration into upper laryngeal vestibule and residue in pyriforms with risk of aspiration. In this case, the patient is experiencing dysphagia in the oropharyngeal phase. So, here you will report 787.22.
ICD-10: When you switch to using ICD-10 codes, you will have to use the following options to report dysphagia:
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