Z13.810 — Encounter for screening for upper gastrointestinal disorder
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- For MBSS: documentation that MBSS is being performed by both a speech-language pathologist and a radiologist when dysphagia has been diagnosed and when one or more indications are present (clinical swallow evaluation identifies aspiration risk; follow-up of known swallowing disorder; need to determine diet/liquid consistency; need to determine effectiveness of maneuvers).
- Clinical swallow evaluation results must be documented when used to justify MBSS or FEES (e.g., documentation that clinical exam identifies risk of aspiration or persistent dysphagia).
- For FEES/FEESST: documentation of the specific clinical rationale meeting any of the listed reasons that make FEES preferred (e.g., aspiration-of-barium concerns, need to assess fatigue during a meal, repeat exam to assess change, severe dysphagia with poor swallow reflex, therapeutic exam requiring multiple maneuvers/real foods, need to visualize larynx post-intubation/surgery, problematic positioning/transportation for fluoroscopy, suspicion of compromised laryngeal competence with tracheostomy, transportation barriers).
Key Coverage Criteria
- Modified barium swallow study (MBSS) to evaluate function of the swallowing mechanism when performed by a speech-language pathologist and radiologist when dysphagia has been diagnosed, and there is a need for further follow-up, as indicated by one or more of the following: Need to determine effectiveness of swallowing postures, maneuvers, or strategies to reduce risk of aspiration.
- Both fiberoptic endoscopy and videofluoroscopy for evaluation of swallowing function.
- FEES is the preferred test over videofluoroscopy in the evaluation of a swallowing disorder in any of the following conditions: A more conservative examination than videofluoroscopy is required because of concerns about aspiration of barium, food, and/or liquid.
- FEES is preferred when there is a need to assess fatigue or swallowing status over a meal.
- FEES is preferred for repeat examination to assess change; to assess effectiveness or need for maneuvers.
- FEES is preferred for severe dysphagia with very weak or possibly absent swallow reflex and/or very limited ability to tolerate any aspiration (e.g., brainstem stroke, member tube-fed for prolonged period, very poor pulmonary status, or poor immunologic status).
4 Active Policies
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0248 — Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) and Laryngopharyngeal Endoscopic Esthesiometer (LPEER)
AETNA-CPB-0608 — Salivary Tests
AETNA-CPB-0738 — Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy
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