Fees:
Optimize Reimbursement for Swallowing Test
Published on Wed Mar 01, 2000
When billing for their otolaryngologists involvement in fiberoptic, or functional, endoscopic evaluation of swallowing (FEES), coders need to determine which procedures or services actually were performed and which codes will be recognized by carriers. But this can be difficult for several reasons:
1. CPT has yet to establish a code for this service;
2. Medicare and other carriers differ concerning which existing codes should be used; and
3. FEES is sometimes used to describe other swallowing evaluation treatment and services.
Swallowing studies commonly are performed on patients who have been intubated for a long time and have problems eating. The oldest and most common way to evaluate the patients swallowing ability is a barium study, which usually is performed by a radiologist and a speech pathologist. Video fluoroscopy, a more advanced evaluation method that allows video to be recorded of the patients swallowing many different substances, also is typically performed by the radiologist in conjunction with the speech pathologist.
The FEES study is another way to evaluate swallowing that often is used when these two radiological services cant be performed. In this evaluation, an otolaryngologist usually works alongside a speech pathologist. The otolaryngologist will perform a flexible laryngoscopy while the speech pathologist performs the actual swallowing evaluation. A flexible fiberoptic endoscope is introduced transnasally into the patients hypopharynx by the otolaryngologist, who can then view laryngeal and pharyngeal structures. The patient is then led through various tasks to evaluate the sensory and motor status of the pharyngeal and laryngeal mechanism. Food and liquid boluses are given to the patient to determine the integrity of the pharyngeal swallow.
The examination provides information on the patients ability to protect the airway and to initiate a prompt swallow without spilling material into the hypopharynx, among other things. The most critical finding is aspiration, according to an Aetna US Healthcare coverage policy bulletin, and FEES is able to detect this with good sensitivity.
The most common reason for a FEES evaluation is difficulty in swallowing (787.2, dysphagia), though some neurologic and other disorders also may lead to a swallowing evaluation and/or treatment, says Margaret M. Hickey, RN, MSN, MS, president of the Society of Otorhinolaryngology and Head-Neck Nurses and clinical oncology director at the Tulane Cancer Center in New Orleans.
Coding the Services
Like the barium study, the FEES study is a combination of two or more services. Because there currently is no CPT code for FEES, the components of the study must be broken out and coded separately; alternatively, some Medicare carriers prefer the service to be coded [...]
