Answers to Your Feeding/Swallowing Coding Questions These tips will help you submit accurate and complete documentation to your patients’ payers. Bottom Line
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Bottom Line  |   May 01, 2018
Answers to Your Feeding/Swallowing Coding Questions
Author Notes
  • Neela Swanson is director of ASHA health care policy, coding and reimbursement. nswanson@asha.org
    Neela Swanson is director of ASHA health care policy, coding and reimbursement. nswanson@asha.org×
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Swallowing, Dysphagia & Feeding Disorders / Practice Management / Bottom Line
Bottom Line   |   May 01, 2018
Answers to Your Feeding/Swallowing Coding Questions
The ASHA Leader, May 2018, Vol. 23, 26-28. doi:10.1044/leader.BML.23052018.26
The ASHA Leader, May 2018, Vol. 23, 26-28. doi:10.1044/leader.BML.23052018.26
Do you know which swallowing and feeding codes may not be billed together? Or which diagnosis codes support swallowing treatment? Or how to address less-common scenarios—such as billing for a videofluoroscopic swallow study without recording?
The answers to these and other questions will help you to appropriately report services to Medicare, Medicaid and other third-party payers and avoid claim denials. Clinicians should also check directly with each payer for final guidance on billing and coding requirements.
The CPT (Current Procedural Terminology ® American Medical Association) coding guidance addressed here applies primarily to outpatient billing. Inpatient settings may use CPT codes to track services for administrative and productivity purposes, but not for billing. Each facility has its own criteria for tracking services and determining productivity, but these rules are separate from payment policy.
What are the ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) diagnosis codes that would support swallowing and feeding treatment?
  • The R13.1– series of codes describing the oral, oropharyngeal, pharyngeal and pharyngoesophageal phases of dysphagia are used to report swallowing and feeding disorders related to underlying medical conditions, such as neurological disorders or structural abnormalities.

  • Codes in the I69.– series should also be included on claims for patients with dysphagia following a cerebrovascular accident.

  • ICD-10-CM code R63.3 may be an option when there is a significant feeding disorder but no documented oral motor dysfunction. However, health plans may not cover treatment for issues such as food-texture sensitivity if there is no evidence of an oral-function impairment.

Policies regarding same-day billing of CPT codes vary by payer. However, many payers follow Medicare’s guidance.

What CPT codes do I use for evaluation and treatment of swallowing and feeding disorders?
Report a clinical evaluation of swallowing and feeding with CPT 92610 (evaluation of oral and pharyngeal swallowing function). For treatment, use CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding).
If the patient has a modified barium swallow (MBS) or videofluoroscopic study, report CPT 92611 (motion fluoroscopic evaluation of swallowing function by cine [cineradiography] or video recording), which describes the speech-language pathologist’s role. Do not use CPT 74230, which describes the radiologist’s role (swallowing function, with cineradiography/videoradiography).
Use the 92612–92617 series of CPT codes to report flexible endoscopic evaluation of swallowing and/or laryngeal sensory testing by cine or video recording. If your role is limited to reviewing results and making recommendations (that is, you do not pass the scope), you should use the “interpretation and report only” codes in this series. You cannot bill “interpretation and report only” codes in conjunction with the codes for a full endoscopic evaluation.
Also keep in mind that states and payers have different supervision requirements for endoscopic procedures.
Can I bill for both an instrumental and clinical swallowing evaluation on the same day?
Policies regarding same-day billing of CPT codes vary by payer. However, many payers follow Medicare’s guidance, known as National Correct Coding Initiative (CCI) edits. These edits dictate which CPT codes can or cannot be billed together by the same provider, for the same patient, and on the same day, for Medicare Part B (outpatient) services.
According to CCI, SLPs may bill a clinical swallowing evaluation (CPT 92610) on the same day as any of the other videofluoroscopic or flexible endoscopic evaluations. Documentation should show that the evaluations were separate and distinct services. Some code pairs may require an additional modifier on the claim. Find information on specific code pairs and modifiers online.
SLPs should check with Medicaid and other health plans to verify whether they have their own policies for same-day billing.

Documentation for group swallowing treatment should demonstrate that each patient is working on defined treatment goals, as outlined in the plan of care, and that skilled care was provided.

Can I bill for a treatment session immediately following a swallowing evaluation for the time I spend reviewing compensatory strategies and educating the patient?
According to CCI edits, the CPT code for treatment (CPT 92526) may be billed on the same day as a clinical (CPT 92610), videofluoroscopic (CPT 92611), or endoscopic (CPT 92612–92617) evaluation. However, to appropriately bill for the treatment session, you must document that the evaluation and treatment are separate and distinct services and that the treatment addresses an established plan of care (POC). It may not be appropriate to bill 92526 if there is no POC and a full session addressing established treatment goals hasn’t been completed.
In addition, CPT codes related to evaluation of swallowing include assessment with a continuum of food/liquid consistencies, time spent addressing compensatory strategies, and patient and family/caregiver education. You should not bill a separate treatment code to capture these activities, as they are already included as part of the evaluation.
Is there a CPT code for group swallowing treatment?
No, there is not a specific code that describes swallowing treatment in a group setting. SLPs should check with each payer to determine if group swallowing treatment is covered and, if so, which CPT code to use.
For example, some payers may choose to use CPT 97150 (therapeutic procedure[s], group, 2 or more individuals), and others may opt for CPT code 92508 (treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals).
Documentation for group swallowing treatment should demonstrate that each patient is working on defined treatment goals, as outlined in the plan of care, and that skilled care was provided.
For example, billing for dining groups is not appropriate if the specialized skills of an SLP or other qualified health care professional are not required, even if the clinician is present at the dining group. Find more information on what constitutes skilled care online.
How should I report a videofluoroscopic or flexible endoscopic swallow study if the equipment cannot record the study?
CPT codes for these instrumental assessments require recording to allow a detailed analysis of swallow function after the test. It may not be appropriate to bill these codes if there is no recording mechanism.
An alternative is to report CPT 92700 (unlisted otorhinolaryngologic service or procedure). Claims with 92700 will be reviewed manually for payment. Document the service provided, medical necessity, equipment used, time spent performing the evaluation, and the usual and customary charge for the service.
Find more information on billing for procedures that have no specific code in “New Procedures … But No Codes” online.
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May 2018
Volume 23, Issue 5