CPT code 74220 vs 74230 vs 70370 : Modified Barium Swallow

Basic – Cpt Code 74220/74230 Modified Barium Swallow

Barium swallow studies are coded very frequently in radiology. Studies related to esophagus are done with Barium swallow. Any problem with food swallowing procedures always make physicians to test with barium swallow studies. Esophagram has two CPT codes 74220 and 74230, normal Barium swallow and Modified Barium swallow. Both are done to find any abnormalities like hiatal hernia or gastroesophageal reflux (K21.9), related to swallowing function of esophagus. GI reflux and hiatal hernia always fulfill the medical necessity of modified barium swallow cpt code. 

The diagnosis plays a important role in coding procedure codes. There are other procedure codes for HIDA scan (CPT 78226 & 78227), bone scan, mammogram, chest x-ray, abdominal ultrasound, MRI exam etc. which are performed for specific diagnosis. Also, along with barium swallow exam, we have upper GI series codes (74240-74250), which share similar diagnosis codes. Coding these exams will surely help in improving your coding skills.

Both procedures have common sign and symptoms. Modified barium swallow cpt code requires more specific diagnosis as primary and secondary, to be get paid for some payers in US.

74220, Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study

74221 double-contrast (eg, high-density barium and effervescent agent) study

74230 Swallowing function, with cineradiography/videoradiography (Video Fluoroscopy)

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CPT code for Barium Swallow modified Coding guide

Procedure for CPT code 74220, 74221 & 74230 (barium swallow vs modified barium swallow)

The study is performed on esophagus, a muscular tube, which carried swallowed food and liquids for the pharynx to stomach. Images are obtained of the esophagus, often to evaluate structural abnormalities of the esophagus and vessels. A scout film (one obtained without the use of a contrast medium) may initially be taken of the chest. The patient then swallows a single-contrast (barium sulfate) material in 74220 or a double-contrast (high-density barium and effervescent agent) material in 74221, after which one or more radiographic views are obtained, with or without delayed images. This study is commonly referred to as a “barium swallow.” Abnormalities related to esophagus like reflux, varices etc. are diagnosed with this study. Number and type of views have nothing to do with this exam.

In rare circumstances, a patient’s symptoms may require a more extensive evaluation of the esophagus, particularly of the cervical esophagus, requiring multiple patient positions, video or cine recording , and dual contrast hypopharyngogram images. In these cases, the reporting of both an upper GI code (74240-74251) and a “radiologic examination, pharynx and/or cervical esophagus” code (74210) may be indicated when both procedures are performed in the same session or on the same day.

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Procedure for CPT code for Barium Swallow Modified

In other unusual situations, an examination of swallowing function, pharyngeal and/or esophageal motility or modified barium swallow may also be performed (CPT code 74230) in addition to an upper GI series. This study provides important information about a patient’s ability to ingest materials of varying consistencies from liquid to solid that is not inherent in an upper GI examination. When the swallowing function (code 74230) is performed concurrent with an upper GI, it is reported separately. This code is not included in the CCI edits; therefore, the addition of the 59 modifier is not necessary. 

Modified Barium swallow is slightly advanced compared to barium swallow. In this procedure the patient is placed in upright position and foods and liquids are mixed with barium and given to patient. Fluoroscopic images are obtained once the patient swallows the food and liquids. Here, images are recorded with the help of video recorder which can use for later study as well. So, at this point normal Barium swallow is different from Modified Barium Swallow. In the procedure physician examine behavior of food and liquid in mouth, chewing, swallowing and movement of food in esophagus. Images taken during these process helps in diagnosis of any abnormality related to swallowing function like gastro-esophageal reflux, obstruction, hiatal hernia etc.

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Never bill CPT code 74220 & 74230 together

CPT code for barium swallow (74220) is included in with modified barium swallow procedure code (74230). Edit exists with 74230.  74220 is a Column 2 code. If both 74230 and 74220 are submitted, only 74230 will be paid. 

Modified barium swallow is a more extensive procedure and includes barium swallow exam. NO modifiers associated with the CCI are allowed to be used with this code pair.

CPT codes used for evaluation and treatment of swallowing and feeding disorders

Report a clinical evaluation of swallowing and feeding with CPT 92610 (evaluation of oral and pharyngeal swallowing function). For treatment, use CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding).

If the patient has a modified barium swallow (MBS) or videofluoroscopic study, report CPT 92611 (motion fluoroscopic evaluation of swallowing function by cine [cineradiography] or video recording), which describes the speech-language pathologist’s role. Do not use CPT 74230, which describes the radiologist’s role (swallowing function, with cineradiography/videoradiography).
Use 92612–92617 series of CPT codes to report flexible endoscopic evaluation of swallowing and/or laryngeal sensory testing by cine or video recording. If your role is limited to reviewing results and making recommendations (that is, you do not pass the scope), you should use the “interpretation and report only” codes in this series. You cannot bill “interpretation and report only” codes in conjunction with the codes for a full endoscopic evaluation.
Other related Procedure codes
70370 Radiologic examination; Pharynx or Larynx, including fluoroscopy and/or magnification technique
A radiologic examination is performed to visualize the pharynx, which serves as passage for both food and air, and larynx, or the organ of voice. Films are typically taken to show soft tissues of the neck. The films are often taken while the patient inhales or makes phonetic sounds. The key element of this code is that it includes x-ray fluoroscopy and/or magnification technique in addition to the radiologic exam.
70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording
A radiologic study is performed for pharyngeal and speech evaluation. Cineradiography, or video recording, is employed, as the physiologic event of speech and swallowing occur too rapidly for normal fluoroscopic viewing. High-speed frame rates are used to evaluate speech and swallowing, and later reviewed and interpreted by the radiologist.
Coverage Indications, Limitations, and/or Medical Necessity
The videofluoroscopic swallowing study, also known as the Modified Barium Swallow (MBS), is a videofluoroscopic, radiographic test that differs from the traditional barium swallow procedures (e.g., pharyngoesophagram and upper gastrointestinal series) in both procedure and purpose. During the procedure, the patient is seated in an upright or semi-reclined position and given various quantities and textures of food and/or liquids mixed with a contrast material. The procedure includes observation of containment of the food/liquid in the oral cavity, mastication, tongue mobility during oral bolus transport, elevation and retraction of the velum, tongue base retraction, upward and forward movement of the hyoid bone and larynx, laryngeal closure, pharyngeal contraction, and extent and duration of pharyngoesophageal segment opening. The presence, timing, and cause of penetration or aspiration into the upper airways are observed. Observations of esophageal clearance in the upright position, sensation and muscle strength may be measured directly or inferred. The videofluoroscopic swallowing study is a collaborative study that can be performed by a speech-language pathologist and a radiologist.

Instrumental assessment of swallowing is indicated for either the evaluation of a patient with dysphagia who has a pharyngeal dysfunction or who is at risk for aspiration.

Among the important clinical syndromes that contribute to the presentation of dysphagia and where instrumental assessment of swallowing may be helpful are:

  • Patients with stroke or other Central Nervous System (CNS) disorder with associated impairment of speech and swallowing.
  • Patients with surgical ablation or radiation due to head and neck cancer with documented difficulty in swallowing.
  • Patients without obvious CNS disorder, but with documented difficulty in swallowing.
  • Patients with generalized debilitation and with difficulty swallowing food.
  • Patients with neuromuscular diseases and rheumatologic diseases known to cause dysphagia.
  • Patients with a clinical history of aspiration or a history of aspiration pneumonia.
  • Patients with head or neck (throat) injury, including peripheral nerve injury from any cause.

Concerns have been expressed that the use of such services in a mobile setting lacks evidence of medical effectiveness. Questions of patient safety have yet to be resolved for these types of procedures to be performed in a skilled nursing facility, nursing home, or home environment, thus requiring physician presence during the procedure in such settings.

Limitations

Place of Services (POS)

This procedure will be reimbursed only when medically necessary and performed in one of the following:

  • Office (11)
  • Inpatient hospital (21)
  • Outpatient hospital (22)
  • Emergency room hospital (23)
  • Comprehensive inpatient rehabilitation facility (61)
  • Comprehensive outpatient rehabilitation facility (62)

Note: This LCD imposes frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

012xHospital Inpatient (Medicare Part B only)
013xHospital Outpatient
021xSkilled Nursing – Inpatient (Including Medicare Part A)
022xSkilled Nursing – Inpatient (Medicare Part B only)
023xSkilled Nursing – Outpatient
075xClinic – Comprehensive Outpatient Rehabilitation Facility (CORF)
085xCritical Access Hospital

 

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all the CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04 Medicare Claims Processing Manual for further guidance.

 

032XRadiology – Diagnostic – General Classification
044XSpeech-Language Pathology – General Classification
ICD9  and ICD10 code for CPT code for Barium Swallow

The most common symptom for Barium swallow study is dysphagia 787.20(R13.10). Difficulty in swallowing leads the harmful diseases like gastro-esophageal reflux, hiatal hernia etc. Hence, whenever we come across cpt 74220, 74230 we usually get 787.20 as symptom or indication. While coding Diagnosis codes for 74230 Modified Barium Swallow we use to code two ICD codes. The Primary codes should the symptom associated with difficult swallowing and the secondary code should be the disorder related to symptoms. 

Report dysphagia with the primary diagnosis of I69.091, I69.191, I69.291, I69.391, I69.891, I69.991, J69.0, R13.0, R13.10-R13.14 or R13.19. At least one of the secondary diagnoses from the secondary diagnoses list below is required for R13.0, R13.10-R13.14 and R13.19. (I69.091, I69.191, I69.291, I69.391, I69.891, I69.991 and J69.0 do not require a secondary diagnosis)

Medicare is establishing the following limited coverage for CPT/HCPCS codes 70370, 70371 and 74230:

Primary Diagnosis

I69.091Dysphagia following nontraumatic subarachnoid hemorrhage
I69.191Dysphagia following nontraumatic intracerebral hemorrhage
I69.291Dysphagia following other nontraumatic intracranial hemorrhage
I69.391Dysphagia following cerebral infarction
I69.891Dysphagia following other cerebrovascular disease
I69.991Dysphagia following unspecified cerebrovascular disease
J69.0Pneumonitis due to inhalation of food and vomit
R13.0*Aphagia
R13.10*Dysphagia, unspecified
R13.11*Dysphagia, oral phase
R13.12*Dysphagia, oropharyngeal phase
R13.13*Dysphagia, pharyngeal phase
R13.14*Dysphagia, pharyngoesophageal phase
R13.19*Other dysphagia

Note: Codes R13.0, R13.10-R13.14 and R13.19 as the primary diagnosis require a secondary (dual) diagnosis from the codes below

               

ICD 10 secondary diagnosis codes covered with CPT code barium swallow modified

A31.0Pulmonary mycobacterial infection
B91Sequelae of poliomyelitis
C00.0Malignant neoplasm of external upper lip
C00.1Malignant neoplasm of external lower lip
C00.2Malignant neoplasm of external lip, unspecified
C00.3Malignant neoplasm of upper lip, inner aspect
C00.4Malignant neoplasm of lower lip, inner aspect
C00.5Malignant neoplasm of lip, unspecified, inner aspect
C00.6Malignant neoplasm of commissure of lip, unspecified
C00.8Malignant neoplasm of overlapping sites of lip
C00.9Malignant neoplasm of lip, unspecified
C01Malignant neoplasm of base of tongue
C02.0Malignant neoplasm of dorsal surface of tongue
C02.1Malignant neoplasm of border of tongue
C02.2Malignant neoplasm of ventral surface of tongue
C02.3Malignant neoplasm of anterior two-thirds of tongue, part unspecified
C02.4Malignant neoplasm of lingual tonsil
C02.8Malignant neoplasm of overlapping sites of tongue
C02.9Malignant neoplasm of tongue, unspecified
C03.0Malignant neoplasm of upper gum
C03.1Malignant neoplasm of lower gum
C03.9Malignant neoplasm of gum, unspecified
C04.0Malignant neoplasm of anterior floor of mouth
C04.1Malignant neoplasm of lateral floor of mouth
C04.8Malignant neoplasm of overlapping sites of floor of mouth
C04.9Malignant neoplasm of floor of mouth, unspecified
C05.0Malignant neoplasm of hard palate
C05.1Malignant neoplasm of soft palate
C05.2Malignant neoplasm of uvula
C05.8Malignant neoplasm of overlapping sites of palate
C05.9Malignant neoplasm of palate, unspecified
C06.0Malignant neoplasm of cheek mucosa
C06.1Malignant neoplasm of vestibule of mouth
C06.2Malignant neoplasm of retromolar area
C06.80Malignant neoplasm of overlapping sites of unspecified parts of mouth
C06.89Malignant neoplasm of overlapping sites of other parts of mouth
C06.9Malignant neoplasm of mouth, unspecified
C07Malignant neoplasm of parotid gland
C08.0Malignant neoplasm of submandibular gland
C08.1Malignant neoplasm of sublingual gland
C08.9Malignant neoplasm of major salivary gland, unspecified
C09.0Malignant neoplasm of tonsillar fossa
C09.1Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8Malignant neoplasm of overlapping sites of tonsil
C09.9Malignant neoplasm of tonsil, unspecified
C10.0Malignant neoplasm of vallecula
C10.1Malignant neoplasm of anterior surface of epiglottis
C10.2Malignant neoplasm of lateral wall of oropharynx
C10.3Malignant neoplasm of posterior wall of oropharynx
C10.4Malignant neoplasm of branchial cleft
C10.8Malignant neoplasm of overlapping sites of oropharynx
C10.9Malignant neoplasm of oropharynx, unspecified
C11.0Malignant neoplasm of superior wall of nasopharynx
C11.1Malignant neoplasm of posterior wall of nasopharynx
C11.2Malignant neoplasm of lateral wall of nasopharynx
C11.3Malignant neoplasm of anterior wall of nasopharynx
C11.8Malignant neoplasm of overlapping sites of nasopharynx
C11.9Malignant neoplasm of nasopharynx, unspecified
C12Malignant neoplasm of pyriform sinus
C13.0Malignant neoplasm of postcricoid region
C13.1Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2Malignant neoplasm of posterior wall of hypopharynx
C13.8Malignant neoplasm of overlapping sites of hypopharynx
C13.9Malignant neoplasm of hypopharynx, unspecified
C14.0Malignant neoplasm of pharynx, unspecified
C14.2Malignant neoplasm of Waldeyer’s ring
C14.8Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3Malignant neoplasm of upper third of esophagus
C15.4Malignant neoplasm of middle third of esophagus
C15.5Malignant neoplasm of lower third of esophagus
C15.8Malignant neoplasm of overlapping sites of esophagus
C15.9Malignant neoplasm of esophagus, unspecified
C30.0Malignant neoplasm of nasal cavity
C30.1Malignant neoplasm of middle ear
C31.0Malignant neoplasm of maxillary sinus
C31.1Malignant neoplasm of ethmoidal sinus
C31.2Malignant neoplasm of frontal sinus
C31.3Malignant neoplasm of sphenoid sinus
C31.8Malignant neoplasm of overlapping sites of accessory sinuses
C32.0Malignant neoplasm of glottis
C32.1Malignant neoplasm of supraglottis
C32.2Malignant neoplasm of subglottis
C32.3Malignant neoplasm of laryngeal cartilage
C32.8Malignant neoplasm of overlapping sites of larynx
C32.9Malignant neoplasm of larynx, unspecified
C76.0Malignant neoplasm of head, face and neck
C77.0Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
C78.80Secondary malignant neoplasm of unspecified digestive organ
C78.89Secondary malignant neoplasm of other digestive organs
D10.1Benign neoplasm of tongue
D10.2Benign neoplasm of floor of mouth
D10.30Benign neoplasm of unspecified part of mouth
D10.39Benign neoplasm of other parts of mouth
D10.4Benign neoplasm of tonsil
D10.5Benign neoplasm of other parts of oropharynx
D10.6Benign neoplasm of nasopharynx
D10.7Benign neoplasm of hypopharynx
D10.9Benign neoplasm of pharynx, unspecified
D11.0Benign neoplasm of parotid gland

 

Only one of these two (74230 and 74220) codes is usually reported for the study, depending on the nature of the evaluation. Codes 74210 and 74230 are not reported in conjunction with one another.

 

 References:

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35433&ver=23&name=331*1&UpdatePeriod=749&bc=AAAAEAAAAAAAAA%3d%3d&

http://www.acr.org/Advocacy/Economics-Health-Policy/Billing-Coding/Coding-Source-List/2009/May-Jun-2009/Coding-for-an-Upper-GI-Series-and-Esophagram

https://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/you-be-the-coder-barium-swallow-article

7 Thoughts to “CPT code 74220 vs 74230 vs 70370 : Modified Barium Swallow”

  1. […] denied when it is totally inclusive in the primary procedure. Let understand with and example. For modified barium swallow 74230 and Normal Barium swallow 74220, we performed on same day in same setting; we are not allowed to […]

  2. […] example,  the  barium swallow and modified barium swallow procedure code, which is little difficult to understand until you have coded them before. Similarly, the bone scan […]

  3. […] Read also: Best coding guide for Modified barium swallow CPT codes […]

  4. […] Modified Barium Swallow (74230) […]

  5. […] examination of speech sound production, articulatory movements of oral musculature, oral-pharyngeal swallowing function, qualitative analysis of voice and resonance, and measures of frequency, type, and […]

  6. […] esophageal motility. Patients who have had strokes and cannot be treated surgically or by drugs for swallowing dysfunctions may require assistance from a rehabilitation specialist. In severe cases, the […]

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