I have had questions from a few different people about this topic recently, so I figured I would address it in a blog post. I typically tell SLPs that they can bill a dysphagia treatment code on the day of the FEES exam for the time that they were with the patient minus the time that I was scoping the patient. My report includes the scope time and length of exam in minutes. If you (the SLP) are present for the exam, you can bill for the additional time that you were present and providing treatment.
Questions that have come up recently include… Can two SLPs bill on the same day for the same patient? Can these two different billing codes (FEES and dysphagia treatment code) be billed on the same day? The concern being that if two SLPs or two codes were billed, that the facility wouldn’t appropriately be reimbursed for services or that funding would be retracted at a later date.
Insurance does not limit the number of therapists a patient can see in a day, but the providers can't be overlapping in their services. The SLP completing the FEES exam is assessing pharyngeal function (something that can't be done during a clinical bedside). The SLP billing for treatment is providing treatment and education prior to the exam, as well as after, based on information gained from the FEES. One is evaluating, one is treating therefore there is no overlap in services. Make sure that you clearly state the treatment that you provided and provide the specific time range you were with the patient (outside of the scoping time). I give you a brief example of what you might include in your treatment note below.
As for billing two codes on the same day, there is a helpful article on ASHA’s website that I have linked below. The table you want is the NCCI edits table. It shows what can or cannot be billed on the same day. It also includes codes that if billed on the same day, what is allowed with a 59 modifier or not. The 92612 code is for FEES and the 92526 code (dysphagia treatment) are not in the “cannot bill column.” I hope this is helpful and please feel free to share with others who will find this helpful. I’ve added the link to the ASHA website article below, along with a sample treatment SOAP note.
Sample SOAP Note
S: Pt sitting up in bed, alert and agreeable to exam. Asking for sips of water before exam which SLP provided.
O: Assisted patient with oral care prior to exam in order to provide clean and moist oropharyngeal mucosa prior to PO. Provided education in preparation for FEES exam. Pt required moderate visual cues in order maximize understanding of exam process and procedures. Once exam complete, SLP provided education regarding initial results of exam (as indicated by FEES SLP), recommendations and plan. Initiated training of _____ exercise/strategy with 5 ml thin liquid by spoon.
A: Pt was receptive to all education and training provided. Pt would benefit from ongoing SLP intervention in order to maximize safety and independence with PO intake and implement dysphagia rehabilitation techniques.
P: Further review of FEES findings, recommendations and interventions with patient, family and caregivers. Continue training of dysphagia rehabilitation exercises and teaching of compensatory strategies.
You will likely be more detailed in your own note, but this gives you an idea what things to comment on.