What is dysphagia?

Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. Consequences of dysphagia include malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death. Adults with dysphagia may also experience disinterest, reduced enjoyment, embarrassment, and/or isolation related to eating or drinking. Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patient’s family (from ASHA.org)

Who is a candidate for FEES?

Patients with feeding tubes, isolation precautions, dementia, bariatric patients, supplemental oxygen, ventilator dependent, tracheostomy tube placements, speaking valves and medically complex patients. FEES can be completed on any patient without evidence of bilateral nasal obstruction. recent facial maxillary or nasal fractures, or severe epistaxis (nose bleeds).

How do you bill?

FEES procedure is considered a speech language pathology therapy service (CPT Code 92612). All therapy services fall under the Consolidated Billing rules as of the Balanced Budget Act of 1997. If a FEES procedure is completed in the subacute setting, the facility is responsible for payment to provider directly for the procedure per CMS guidelines. The facility then bills the patient's fiscal intermediary for reimbursement. For more information: http://www.cms.gov/SNFPPS/05_ConsolidatedBilling.asp

Can you assess voice and diagnose a voice disorder?

FEES provides a view the larynx and the pharynx and how they function for swallowing and can screen for voice disorders. If a vocal abnormality is seen in these areas during a FEES, a referral would be made to an ENT for further assessment.

What are costs associated with dysphagia?

• The average cost of a re-hospitalization due to any of the aforementioned conditions can cost a facility approximately $30,000.

• The cost to keep 1 resident on thickened liquids for 1 year can cost your facility between $2,000-$7,000 annually.

• The cost of managing a patient with a feeding tube, which for many has been the primary treatment option for dysphagia is reported to average over $31,000 per patient per year, with 70% of patient’s reporting serious medical complications. (Hwang et al., 2014)

• Aspiration pneumonia is the leading cause of death and the most common complication arising from dysphagia for long term care residents. (Oh et al., 2004).

Resources

• Aviv, J.E., Kaplan, S.T., Thompson, J.E., Spitzer, J., Diamond, B., & Close, L.G. (2000).  The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEEST): An analysis of 500 consecutive evaluations. Dysphagia, 15(1), 39-44.

• Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., & Gartner, C. (2005). Flexible endoscopic evaluation of swallowing with sensory testing: Patient characteristics and analysis of safety in 1,340 consecutive examinations.  Annals of Otology, Rhinology & Laryngology. 114, 173-176.

• Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., & Guss, J. (2003).  The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting.  The Laryngoscope. 113(1), 21-24.

• Langmore, S.E., Skarupski, K.A., Park, P.S., Fries, B.E. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002; 10.1007/s00455-002-0072-1.