Speech-language pathologists often call ASHA with questions on coding and reimbursement for services involving swallowing evaluation and treatment. The following questions and answers should provide guidance for the most common concerns.
Q: Which ICD-9-CM codes (International Classification of Diseases, 9th Revision, Clinical Modification) should be used for dysphagia?
Several ICD-9-CM codes allow SLPs to provide an appropriate dysphagia diagnosis:
- 787.20 Dysphagia, unspecified
- 787.21 Dysphagia, oral phase
- 787.22 Dysphagia, oropharyngeal phase
- 787.23 Dysphagia, pharyngeal phase
- 787.24 Dysphagia, pharyngoesophageal phase
- 787.29 Other dysphagia
For dysphagia due to the late effects of cerebrovascular disease, SLPs should use 438.82 coupled with an additional code from the 787.20–787.29 series to identify the specific type of dysphagia, if appropriate.
Q: What are the uses for the "unspecified" or "other" dysphagia ICD-9 codes?
- 787.20 Dysphagia, unspecified—This term could be defined as "not otherwise specified" (NOS), meaning that the information in the medical record is insufficient to assign a more specific diagnosis other than "dysphagia." A possible scenario for the use of this code is physician referral of a patient with a diagnosis of 787.20 to an SLP for a swallowing assessment. The SLP would then provide a more definitive diagnosis (787.21-787.24).
- 787.29 Other dysphagia—This term could be defined as "not elsewhere classified" (NEC) and would be used for a specific dysphagia disorder that has not been identified in the current ICD-9-CM. The diagnosis is assigned to this "other" code rather than to the "unspecified" code. The National Center for Health Statistics has indexed the following terms to 787.29: cervical dysphagia and neurogenic dysphagia.
Q: Which CPT codes (Current Procedural Terminology©) should be used for dysphagia-related services?
SLPs can use the following codes:
- 92526 Treatment of swallowing dysfunction and/or oral function for feeding
- 92610 Evaluation of oral & pharyngeal swallowing function
- 92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording (MBS)
- 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording (FEES)
- 92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording
- 92616 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing (FEEST)
Other CPT codes for physicians that include interpretation and report of an endoscopic instrumental assessment (92613, 92615, and 92617) are optional. These codes are used only by physicians who review the recordings to look for particular problems (e.g., a disease or anatomical abnormality) and prepare their own report. Interpretation and report writing by the SLP are included in the instrumental assessment codes.
Q: What are the restrictions on same-day billing of dysphagia CPT codes?
The Centers for Medicare and Medicaid Services and many private payers use an automated edit system, the National Correct Coding Initiative (CCI), to control specific code pairs that can be reported on the same day. The CCI edits specify a number of dysphagia-related code pairings that either cannot be billed together or require the modifier "59" to indicate that they are distinctly separate procedures. For example, CPT 92612 (FEES) may not be reported on the same day as CPT 92614 (sensory testing). CPT 92610 (swallowing evaluation), however, may be reported on the same day as CPT 92611 (MBS) when the "59" modifier is applied.
For a complete listing of dysphagia-related CCI edits, go to ASHA's Coding for Reimbursement Web site.
Q: Is there a group dysphagia treatment code?
No, there is no CPT code specific to group treatment for dysphagia. SLPs should consult individual payers to determine if there is an appropriate code to submit for billing purposes.