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Radiology Coding Alert

Correct Coding of Swallowing Studies Optimizes Payup

- Published on Wed, Mar 01, 2000
"Confusion about what was studied and recorded when swallowing studies are done causes coding errors that result in denials and loss of reimbursement. Medicare policy outlines three radiologic codes that may be assigned during swallowing studies conducted using videofluoroscopy:

74230: (swallowing function, pharynx and/or esophagus, with cineradiography and/or video).

70371: (complex dynamic pharyngeal and speech evaluation by cine or video recording);

70370: (radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique);

Radiology coders express confusion about the distinctions between these codes, particularly between 70371 and 74230. There is significant difference in the relative value units (RVUs) assigned them, as well, which makes it even more important for coders to understand and report these codes correctly. CPT 74230 carries an RVU of 26.38, while 70371 carries a 41.35 value.

Contributing to the confusion are the characteristics these procedures have in common. Each involves the use of fluoroscopy to examine the structure and function of the anatomy found in the mouth and throat during the act of swallowing. Speech pathologists may be involved in both studies. The differences lie in what is studied.

74230Risk for Aspirating Food into Airway. CPT 74230 describes what is often termed a classic modified barium swallow. Pioneered by Jeri Logemann, Ph.D., professor of communication sciences and disorders at Northwestern University and current president of the American Speech, Language and Hearing Association, this study documents how the oral cavity, pharynx and the upper esophagus perform while a patient swallows.

It is most often performed on patients who have had a stroke (436, acute, but ill-defined, cerebrovascular disease; 438.11, late effects of cerebrovascular disease, aphasia; 438.12, late effects of cerebrovascular disease, dysphasia) or who suffer from Parkinsons disease (332.0-332.1). Other diagnosis codes that may be used to justify 74230 include 150.0150.9, malignant neoplasms of esophagus; 235.6, neoplasm of uncertain behavior of larynx; and 507.0, pneumonitis due to solids and liquids, due to inhalation of food or vomitus.

This assessment can be done to evaluate both speech and swallowing problems, she says. It is especially valuable when used to evaluate patients at risk for aspirating food into their airway (trachea and lungs) while eating.

During the exam, videofluoroscopy is used to view the function of the mouth, pharynx (which closes as food progresses through it during the swallow) and cervical esophagus. Graduated amounts of thin liquids and, eventually, solid foods are given to the patient, and his or her ability to swallow each is measured. The radiologist and speech language pathologist conduct a fluorographic study, which is recorded on [...]

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