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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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).

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.

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.

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

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

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