Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

 

Contractor Name

CareFirst of Maryland Inc., Medicare Part A

Contractor Number

00190

Contractor Type

Fiscal Intermediary

LCD Database ID Number

L758

LCD Title

Fiberoptic Endoscopic Examination of Swallowing Safety (FEESS) and

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)

Contractor's Determination Number

00-02-R4

AMA/CPT and ADA/CDT Copyright Statement

CPT codes, descriptions, and other data only are copyright 1999 American Medical Association (or such publication of CPT). All rights reserved. Applicable FARS/DFARS clauses apply.  CDT-4 codes and descriptions are Ó 2004 American Dental Association.  All rights reserved.

CMS National Coverage Policy

  • Establishment of national policy supersedes all previous contractor policy statements, including Local Medical Policy coverage guidelines
  • Title XVIII of the Social Security Act, section 1862 (a) (7). This section excludes routine physical examinations.
  • Title XVIII of the Social Security Act, section 1862 (a) (1) (A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Primary Geographic Jurisdiction

Maryland

Washington, DC

Secondary Geographic Jurisdiction

Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Washington state, and Wyoming

Oversight Region

Region III

CMS Consortium

Northeast

DMERC Region LCD Covers

N/A

Original Determination Effective Date

03/13/2000

Revision Effective Date

R-4      04/01/2004

R-3      01/01/2003

R-2      8/10/2001

R-1      01/05/2001

Indications and Limitations of Coverage and/or Medical Necessity

Dysphagia is difficult or impaired swallowing and most often reflects organic disease involving the esophagus, proximal stomach, gastroesophageal junction, or pharynx. Patients' complaints may include the sensation of food "sticking," "stopping," or "hanging up," which is usually felt above or at the level of the abnormality. Patients with dysphagia are at risk for aspiration.

An evaluation of the patient's swallowing mechanism may include multiple processes such as a clinical bedside evaluation of swallowing, an evaluation of oral-motor functioning or videofluoroscopic assessment.

Fiberoptic Endoscopic Examination of Swallowing Safety (FEESS)

Description

This procedure utilizes a fiberoptic laryngoscope, which is passed transnasally to the hypopharynx, where the larynx and surrounding structures are viewed. Detailed information regarding the anatomy and physiology and motor assessment of the pharyngeal stage of swallowing is obtained. Therapeutic maneuvers are attempted during this examination to determine a safe diet and to maximize the efficiency of the swallow.

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)

Description

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) is an alternative to modified barium swallow evaluation of patients at risk for aspiration. The procedure utilizes the passage of a specially equipped flexible endoscope into the oropharynx. The special equipment includes a sensory stimulator that allows quantification of stimuli, a television monitor, a video printer, and a videocassette recorder.

Sensory evaluation is completed by delivering pulses of air at sequentially increased pressures to elicit the laryngeal adductor reflex. Motor evaluation is completed by giving various food items with different consistencies while factors such as oral transit time, inhibition of swallowing, laryngeal elevation, spillage, residue, condition of swallow, laryngeal closure, reflex, aspiration, and ability to clear residue, are monitored.

The entire procedure may be performed at the bedside. The use of topical anesthesia may interfere with the sensory test and is usually not indicated.

Indications

Fiberoptic Endoscopic Examination of Swallowing Safety (FEESS)

This procedure will incorporate both the placement of the flexible fiberoptic laryngoscope and the evaluation of swallowing and oral function for feeding.

The procedure code encompasses the entire procedure and should not be billed more than one time for the same patient on the same day.

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)

The clinical efficacy and applicability of the addition of sensory testing to the FEESS procedure has not been determined. These services will not be reimbursed at a higher amount than the FEESS procedure.

Indications for FEESS and FEESST

FEESS and FEESST may be indicated for the evaluation of a patient with dysphagia who is at risk for aspiration.

These procedures may be indicated for the following clinical syndromes:

  • Patients with stroke or other Central Nervous System (CNS) derangement with associated impairment of speech and swallowing,
  • Patients without obvious CNS disorder, but with documented difficulty in swallowing,
  • Patients with a clinical history or aspiration or a history of aspiration pneumonia,
  • Presence of oral motor disorders with symptoms such as drooling, oral food retention, leakage of food or liquids placed in he mouth, and;
  • Lack of coordination, sensation loss, postural difficulties or other neuromotor disturbances affecting oropharyngeal abilities necessary to close the buccal cavity and/or bite, chew, suck, shape, and squeeze the food bolus into the upper esophagus while protecting the airway.

The results of FEESS and FEESST testing should be used in the clinical decisions affecting the every day dietary management of the impaired patient, and to order/plan/evaluate appropriate therapy programs; for example, whether or not to place a gastrostomy tube for feeding.

Limitations

These services can be performed only under the direct supervision of a physician. Direct supervision outside the office setting requires the physician to have face-to-face contact with the patient and to be in the room while the auxiliary personnel are rendering the service. The physician must remain with the patient and auxiliary personnel for the duration of the treatment. The availability of the physician by telephone and the presence of the physician somewhere in the facility do not constitute direct supervision.

Direct supervision in the office setting does not mean that the physician must be physically present in the same room with the auxiliary personnel. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the auxiliary personnel are performing services. Availability of the physician by telephone does not constitute direct supervision.

The use of topical anesthesia may interfere with the sensory test and is usually not indicated.

FEESST is not recommended if the suspected pathology is an esophageal lesion.

Coverage Topics

Outpatient Hospital Services

Bill Type Codes

11X, 13X, 14X, 18X, 21X, 83X, 85X

Revenue Codes

420, 430, 440

CPT/HCPCS Codes

The AMA and CMS require the use of short descriptors for policies published on the Web. Refer to the CPT book for the long description of the following codes:

92612

Ó 

Endoscopy swallow test (FEESS)

92613

Ó

Endoscopy swallow test (FEESS)

92614

Ó

Laryngoscopy sensory test

92615

Ó

Eval laryngoscopy sense test

92616

Ó

FEES w/laryngeal sense test

92617

Ó

Interpret FEES/laryngeal test

Ó CPT American Medical Association

Does the “CPT 30% Coding Rule” Apply?

N/A

ICD-9 Codes that Support Medical Necessity

ICD-9-CM code listings may cover a range and include truncated codes. It is the provider’s responsibility to avoid truncated codes by selecting a code(s) carried out to the highest level of specificity and selected from the ICD-9-CM book appropriate to the year in which the claim is submitted.

It is not enough to link the procedure code to a correct, payable ICD-9-CM code. The diagnosis or clinical suspicion must be present for the procedure to be paid.

Covered for:

332.0

 

Paralysis agitans

332.1

 

Secondary Parkinsonism

333.0

 

Other degenerative diseases of the basal ganglia

333.2

 

Myoclonus

333.4

 

Huntington's chorea

333.5

 

Other choreas

333.6

 

Idiopathic torsion dystonia

333.81-333.89

 

Fragments of torsion dystonia

333.90-333.99

 

Other and unspecified extrapyramidal diseases and abnormal movement disorders

335.20

 

Amyotrophic lateral sclerosis

341.0-341.9

 

Other demyelinating diseases of central nervous system

342.00-342.92

 

Hemiplegia and hemiparesis

436

 

Acute, but ill-defined, cerebrovascular disease

438.11

 

Speech and language deficits, aphasia

438.12

 

Speech and language deficits, dysphasia

438.20-438.22

 

Hemiplegia/hemiparesis

438.82

 

Other late effects of cerebrovascular disease; dysphagia

507.0

 

Pneumonitis due to inhalation of food or vomitus

783.3

 

Feeding difficulties and mismanagement

784.9

 

Other symptoms involving head and neck (choking sensation)

787.2

 

Other late effect of cerebrovascular disease, dysphagia

933.1

 

Foreign body in larynx

934.0-934.1

 

Foreign body in trachea, bronchus and lung

934.8-934.9

 

 

V48.3

 

Mechanical and motor problems with neck and trunk

 

Diagnoses that Support Medical Necessity

N/A

 

ICD-9 Codes that DO NOT Support Medical Necessity

N/A

 

Diagnoses that DO NOT Support Medical Necessity

N/A

Documentation Requirements

  • Documentation supporting the medical necessity should be legible, maintained in the patient's medical record, and available to Medicare upon request.

Utilization Guidelines

Medicare will monitor the utilization of this service through the Medical Review process.

Sources of Information and Basis for Decision

  • TrailBlazer Health Enterprise, LLC, Part B Newsletter No. 030, February 10,1999
  • Intermediary Medical Director
  • Speech Language Pathology Consultant
  • Empire Medicare Services Medical Policy
  • Veritus Medicare Services Medical Policy

Advisory Committee Notes

This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from the appropriate specialty (ies).

Advisory Committee Meeting Date:

Start Date of Comment Period

11/05/1999

End Date of Comment Period

12/21/1999

Start Date of Notice Period

02/11/2000

Revision History Number

R-4

R-3

R-2

R-1

Revision History Explanation

Number

 

Change

00-02-R4

 

HCPCS 92610 was removed from this policy. Converted from LMRP to LCD format.

 

 

Expanded 438.2 to 438.20-438.22.

00-02-R3

 

Annual updates to CPT/HCPCS codes. Codes G0193, G0194, G0195 discontinued

 

 

with a 3-month grace period, and addition of 92610, 92612-92617.

00-02-R2

 

Erroneously added G0196 to this policy.

00-02-R1

 

Replaced HCPCS codes 31575, 92520, and 92525 with G0193, G0194, G0195,

 

 

and G0196.

 

Does this LCD contain a “Least Costly Alternative” provision?

No

 

Italicized and or quoted material is excerpted from the American Medical Association Current Procedural Terminology CPT codes, descriptions and other data only are copyrighted 1999 American Medical Association (or such other publication of CPT). All rights reserved. Applicable FARS/DFARS apply.