CPT Code 92610: Evaluation of Swallowing Function

What is CPT code 92610?

CPT code 92610 evaluates oral and pharyngeal swallowing function. This procedure code, established by the American Medical Association, covers the assessment of a patient's ability to swallow safely and effectively. The evaluation is typically performed by qualified speech-language pathologists and speech therapists who specialize in diagnosing and treating swallowing disorders.

The 92610 CPT code specifically describes a clinical, non-instrumental assessment of swallowing function that examines the oral preparatory, oral transit, and pharyngeal phases of swallowing.

During this procedure, healthcare providers carefully observe and document various aspects of the patient's swallowing function, including:

• Oral motor function
• Tongue movement and strength
• Lip seal and function
• Mastication abilities
• Laryngeal elevation
• Cough reflex and throat clearing
• Coordination of breathing and swallowing

CPT code 92610 documentation requirements

Proper documentation is essential for fully reimbursing speech therapy services related to swallowing evaluation. When documenting services under CPT code 92610, healthcare professionals should include:

Patient history and presenting symptoms

This includes the following information:

• Detailed medical history relevant to swallowing function
• Current complaints and symptoms related to swallowing difficulties
• Impact of swallowing problems on nutrition, hydration, and quality of life
• Previous treatments or compensatory strategies attempted

Assessment procedures

Documentation should clearly describe all assessment procedures performed, which may include:

• Oral mechanism examination
• Cranial nerve assessment related to swallowing
• Trial swallows with various food and liquid consistencies
• Observations of clinical signs of aspiration or penetration
• Use of specialized equipment or standardized tests
• Video recording of the evaluation, when applicable

Clinical findings and interpretation

The documentation must include objective findings from the evaluation of oral and pharyngeal swallowing function, such as:

• Specific deficits in the oral preparatory, oral transit, or pharyngeal phases
• Signs and symptoms of aspiration or penetration
• Effectiveness of compensatory strategies tested
• Impact of posture, food texture, or liquid consistency on swallowing safety

Recommendations and plan of care

Complete documentation includes recommendations based on the evaluation results:

• Need for further diagnostic testing (e.g., instrumental assessment)
• Specific therapy approaches recommended
• Frequency and duration of proposed treatment
• Referrals to other healthcare providers
• Diet modifications or precautions
• Patient/caregiver education provided

CPT code 92610 billing guidelines

Understanding the accurate billing guidelines for speech therapy CPT codes is crucial for healthcare providers to receive reimbursement and avoid claim denials.

Coverage and eligibility

CPT code 92610 is generally covered by Medicare, Medicaid, and private insurance when the service is medically necessary and provided by a qualified speech language pathologist. However, coverage may vary based on:

• Payer policies regarding speech language pathology services
• Medical necessity documentation
• Provider credentials and facility type
• Prior authorization requirements

Modifier usage

Proper use of modifiers can affect reimbursement for CPT code 92610:

• Modifier 59: This indicates that the evaluation of swallowing function is a separate service from other procedures performed on the same day.
• Modifier 52: This is used for reduced services.
• Modifier GN: Required for Medicare to indicate services delivered under a speech-language pathology plan of care

Billing frequency

Most payers limit how often CPT code 92610 can be billed for the same patient. Typically, a re-evaluation (using the same code) is covered when there is a documented change in the patient's condition or to assess progress after a treatment period. Medicare generally allows this evaluation once yearly unless significant changes in the patient's swallowing function are documented.