CPT Code 92611 for Dysphagia Evaluation

Dysphagia, or difficulty swallowing, is a common medical condition that can affect people of all ages. It occurs when there is a problem with the swallowing mechanism, often resulting in food or liquid going down the airway into the lungs. Dysphagia can lead to serious complications such as aspiration pneumonia, malnutrition, and dehydration.

An important tool for evaluating swallowing disorders is the modified barium swallow study (MBSS), also known as a videofluoroscopic swallow evaluation. This radiographic procedure assesses the oral preparatory, oral, pharyngeal, and esophageal stages of swallowing by having the patient ingest liquids and solids mixed with barium sulfate. The exam is recorded so the swallowing mechanism can be examined in real time on video.

CPT code 92611 is used to report modified barium swallow studies or videofluoroscopic swallow evaluations. This code is found in the Medicine section of the CPT codebook under Special Otorhinolaryngologic Services.

Key Details About CPT Code 92611

• Formal name: Motion fluoroscopic evaluation of swallowing function by cine or video recording. This procedure may also be referred to as a modified barium swallow study (MBSS) or videofluoroscopic swallow evaluation.
• Section in CPT codebook: Medicine / Special Otorhinolaryngologic Services
• Code type: Evaluation and therapeutic otorhinolaryngologic services.
• Relative value units (RVUs): 1.42
• Global period: XXX
• Modifiers: 59 – Distinct Procedural Service
• Billing guidelines: 92611 describes the interpretation and report. Use 92610 for fluoroscopic guidance provided during the exam. 92611 is typically billed along with 74230 to describe radiologic supervision and interpretation.

Appropriate Use of CPT Code 92611

CPT code 92611 is used to report the physician’s interpretation of a modified barium swallow study. This code should be used when:

• A speech language pathologist performs the MBSS exam on the patient
• A radiologist or other physician examines the recorded swallowing activity and issues a report
• The report provides information about swallowing function to aid in diagnosis and treatment planning

92611 should only be used by the physician interpreting the study. It is not appropriate for speech therapists to use this code.

CPT code 92611 can be billed in conjunction with 74230 (radiologic supervision and interpretation of swallowing function) when indicated. It is important to list 92611 as the first code on the claim form when billing with 74230.

Coverage and Billing for 92611

Most private insurance plans cover medically necessary MBSS exams by speech therapists and physician interpretation and reporting when dysphagia is suspected.

Prior authorization may be required, so it is important to check plan policies before scheduling the procedure. Medicare also covers 92611 when reasonable and necessary criteria are met.

When billing 92611, supporting documentation should note signs and symptoms indicative of dysphagia. Relevant ICD-10 diagnosis codes such as:

• R13.10 (Dysphagia, unspecified)
• R13.11 (Dysphagia, oral phase)
• R13.12 (Dysphagia, oropharyngeal phase)
• R13.13 (Dysphagia, pharyngeal phase)
• R13.14 (Dysphagia, pharyngoesophageal phase)
• R13.19 (Other dysphagia)

The Role of 92611 in Dysphagia Evaluation and Management

The modified barium swallow study provides valuable information to help:

• Identify the phase(s) of swallowing that are impaired
• Detect aspiration into the airway
• Assess effectiveness of patient compensatory strategies
• Determine whether certain food/liquid consistencies or swallowing maneuvers improve swallow safety and efficiency
• Establish appropriate diet recommendations
• Aid in treatment planning and therapy goal-setting

The interpreting physician’s report guides the dysphagia management team, which may include the speech-language pathologist, occupational therapist, dietitian, and other providers. Ongoing collaboration ensures optimal, individualized care.

In summary, 92611 is an important CPT code that describes the physician’s professional component of interpreting a modified barium swallow study for dysphagia. When billed with supporting documentation, this code provides appropriate reimbursement for assessing swallowing function and guiding clinical decision-making.

Key Points About 92611:

• Used to report physician interpretation and report of MBSS/videofluoroscopic swallow study
• Shows physician work involved in evaluating recorded swallows and issuing findings
• Should not be used by speech therapists; appropriate for radiologists and other physicians
• Bill along with 74230, list 92611 first
• Supports clinical management of dysphagia when medically necessary