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Thread: 74230?? - I cade for the Radiologist

  1. #11
    Join Date
    Apr 2007
    Richmond Virginia


    AAPC: Back to School
    Quote Originally Posted by tmhgotjss View Post
    i have a question regarding cpt 74230: If the physician does not state in his/her documentation that the patient has "dysphagia", but during the exam patient has aspiration with thin liquid, i cannot code 507.0-aspiration pneumonitis, but can i code unspecified dysphagia 787.20, even though the term "dysphagia" is not documented in the report? For example: How would you code this procedure:

    Modified barium swallow:
    Indication: Feeding difficulty and mismanagement- 783.3
    this study performed under supervision of speech pathologist. Radiologist has provided fluroscopy examination an interpretation.
    On the upright ap view of chest obtained prior to modified barium swallow, cardiac size appears to be normal. Pulmonary vascularity is not engorged. There is no evidence of confluent infiltrates in lungs. The patient was given to swallow thin liquid, liquid of nectar consistency, liguid of honey consistency, applesauce and cookie. With first few swallows of thin liquid there has been evidence of mild to moderate penetration, without aspiration. But at the end of the study again, the patient has been given to swallow thin liquid. At this time there has been aspiration into laryngotracheal airways with mild cough reflex. with swallowing of liquid of nectar, and liguid of honey consistencies, applesauce, and cookie there has been no evidence of penetration or aspiration into larynx.

    The patient has aspirated thin liquid. Thin liquid food items .should be avoided.

    Thanks for any advice.

    ---dysphagia bewildered

    i would either go with your symptoms of feeding difficulties or follow the icd9 codes of aspiration to the 933.x series

  2. #12
    Join Date
    Apr 2007

    Default Medicare denial

    So why if I bill 74230 26 with an diagnosis of dyphagia is Medicare denying the claim. Actually all of my swallow tests are denied. checked the LCD and every thing looks good. they denied stating lacks information for ajudiacation. perhaps notes need to be sent for each one?

  3. #13
    Join Date
    Apr 2007
    Richmond Virginia


    From what I remember from my radiology days, dysphagia requires a second diagnosis that is on the LCD approved list.
    I remember cough was a asecondary code so if the patient had difficulty swallowing and a cough both would have to be reported.

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