ASHA requested a clarification from the Centers for Medicare and Medicaid Services (CMS) regarding the billing policy for treatment of Dysphagia and treatment of Cognitive Skills provided to the same Medicare patient on the same day.

The CPT codes in question are below:

• 97532: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes.
• 92526: Treatment of swallowing dysfunction and/or oral function for feeding.

"CMS responded to the letter, stating "...if an SLP separately performs the services described by CPT code 97532 entirely unrelated to the services described by CPT code 92526, the services may be reported separately." For these cases, the modifier -59 would be added to CPT code 97532."


To see the full article as reported in the ASHA Leader, click on this link: http://www.asha.org/Publications/leader/2012/120515/Bottom-Line--Co-Billing-of-Cognitive,-Dysphagia-Codes.htm

Esophageal dysfunctions are typically re-referred to GI and mostly treated using medications with varying success.  The study concentrating on the utilization of the Effortful Swallow on Esophageal Dysfunctions manometrically examined the effects of an effortful pharyngeal swallow to assess the impact it may have on esophageal function.  The effortful swallow (swallow strong) yielded greater esophageal amplitudes and longer esophageal duration which decreased incomplete bolus clearance.  Wake Forest University, Winston-Salem NC (Butler, et al)  

Effects this study can have on how we conduct Treatment of Esophageal Dysfunction:  We know that the Effortful Swallow improves bolus clearance from the vallecullae and the hypopharynx via increasing effort on swallow.  Anatomically, when a patient uses the Effortful Swallow, they are using as much force as possible to increase hyolaryngeal excursion, and clearance of bolus through to the UES.  The effort used to increase the hyolaryngeal excursion also increases the opening of the UES and the opportunity for bolus to pass through to the UES.  We currently do not have many available options to treat esophageal dysphagia, so this research is exciting news!