Otolaryngology Coding Alert

Question: Should our speech pathologist use the new HCPCS codes G0193 and G0194 instead of 31575 and 31579? If so, which code replaces which?

New Jersey Subscriber

Answer: In the Nov. 1, 2000, Federal Register, HCFA introduced codes G0193 (endoscopic study of swallowing function [also fiberoptic endoscopic evaluation of swallowing][FEES]) and G0194 (sensory testing during endoscopic study of swallowing [add on code], referred to as fiberoptic endoscopic evaluation of swallowing with sensory testing [FEEST]).

According to HCFA, the codes replace 92525 (evaluation of swallowing and oral function for feeding). In addition, 31575 (laryngoscopy, flexible fiberoptic; diagnostic) and 31579 (laryngoscopy, flexible or rigid fiberoptic, with stroboscopy) should no longer be used to describe the otolaryngologists portion of the service.

Two additional G codes were introduced to describe services performed mainly by speech pathologists: G0195 (clinical evaluation of swallowing function) and G0196 (evaluation of swallowing involving swallowing of radio-opaque materials).

The same Federal Register entry that introduced the new codes also stated that the final decision on how to code for FEES and FEEST procedures rests with the carrier, who also has the authority to price the service.

Until now, local Medicare carriers have been inconsistent regarding swallowing evaluations, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs Editorial Panel and Executive Committee. Some carriers cover FEES using existing codes, whereas others may want to see an unlisted code or do not cover the service at all.

Given the variance in coverage policies, you should contact your local Medicare carrier to determine if the service is covered and if the new HCPCS codes are acceptable. Because the carrier also sets the reimbursement level, inquire how much they will pay for the procedure.

When billing private payers, continue to use 92525, 31575 and/or 31579 unless instructed otherwise.

Note: HCFA has not assigned any relative value units to any of the new HCPCS codes.