When four specific dysphagia phase codes go into effect this fall, don't fret if you find yourself opting more often than not for an NOS code. Although using 787.20 won't usually affect payment, make sure you know when to get specific. Pinpoint Specific Phase With 787.21-787.24
Give your ENT and speech language therapists the heads up they-ll need to include the specific type of dysphagia in patients- charts. More important, make sure you set up your computer system to red flag the use of 787.2 (Dysphagia) as an invalid and truncated code. The 2008 update deletes that code and replaces it with five-digit codes (787.20-787.29) that correspond with the following new dysphagia phases:
- oral (787.21)
- oropharyngeal (787.22)
- pharyngeal (787.23)
- pharyngoesophageal (787.24). New Codes, New Benefits Using the specific code when available might help justify billing two procedures, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. Insurance companies are usually looking for a specific diagnosis only when the treatment is specific to a location or disease process.
For instance, an otolaryngologist performs a dilation for pharyngoesophageal dysphagia (43220, Esophagoscopy, rigid or flexible; with balloon dilation [less than 30 mm diameter]) and biopsies a true vocal cord lesion (31535, Laryngoscopy, direct, operative, with biopsy). Using the specific dysphagia diagnosis and the biopsy diagnosis--such as 787.21 for oral dysphagia with 161.0 (Malignant neoplasm of larynx; glottis)--will help justify medical necessity for both scopes.
Default to NOS Code for -Dysphagia- When the medical record makes no distinction other than the diagnosis -dysphagia,- you will have to report 782.20 for -Dysphagia, unspecified,- says Steven C. White, PhD, director of healthcare economics and advocacy for the American Speech-Language-Hearing Association (ASHA) in Rockville, Md. The otolaryngologist could use this as the general diagnosis to identify the reason a patient needs to see a speech-language pathologist for a more definitive diagnosis.
You might classify more claims than you expect to the not otherwise specified (NOS) code. When a patient is not very good at describing his symptoms during an initial dysphagia evaluation, the otolaryngologist might not be able to discern which specific dysphagia code to use (787.21-787.24), Callaway says.
Good news: In these cases, you don't need to ask the ENT for clarification, Callaway says. -Unless you are billing a procedure on a specific body area that requires a specific matching diagnosis,- the payer shouldn't reject the claim due to using an NOS code. Relegate Outlier Dysphagia Dxs to 787.29 If following an evaluation the dysphagia doesn't fall into one of the four new dysphagia phases, opt for 787.29 (Other dysphagia), which is a not elsewhere classified (NEC) code. Unlike 782.20, which indicates [...]