Description of CPT code 92526

92526 Treatment of swallowing dysfunction and/or oral function for feeding

The treatment of swallowing disorders is aimed at finding the specific cause of the dysfunction to treat the problem, such as anti-reflux medications to decrease stomach acidity or improve 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 physician may elect to insert a feeding tube through the nose or in the stomach through the abdomen.

Indications that are covered for CPT code 92526

1. Muscle tone abnormalities that significantly interfering with feeding or swallowing;
2. Oro-facial defects, such as cleft palate, that interfere with feeding or swallowing
3. Delayed or abnormal oral motor development or patterns (e.g., a tonic bite reflex, tongue thrust)
4. Hypersensitive responses to touch, including consistencies and textures, and/or temperature in and around the mouth
5. Inability to properly coordinate feeding, swallowing, and breathing due to prematurity, chronic medical conditions or central nervous system damage
6. Related medical conditions such as gastroesophageal reflux (GER), pharyngeal dysphagia, aspiration or prior tube-feeding that may affect willingness to eat
7. Definite differences/ dysfunction (scores equivalent to 2.0 deviations or greater from the norm) are documented in standardized sensory testing in the area of oral sensory processing, or oral sensory sensitivity

Definitions:

Feeding disorder refers to a condition in which a patient is unable or refuses to eat, or has difficulty eating, which may increase the chance of failing to grow normally. Examples of feeding disorders in children include, but are not limited to, adipsia (the absence of thirst or the desire to drink); dysphagia (difficulty in swallowing); choking, gagging, or vomiting when eating.

Feeding disorders generally present as a food refusal or lower amount of food intake than
that appropriate for age due to behavioral issues [selective diet, anticipatory gagging] or underlying organic conditions [dysphagia, aspiration]. This situation concerns mostly infants and children below 6 years of age; however, feeding problems can appear also later on in life. Feeding disorders commonly encountered in a pediatric setting include food refusal, inadequate intake, over-selectivity, and texture-related problems (Linscheid, 2006).

Feeding/oral function therapy is speech or occupational therapy for oral motor or sensory feeding problems as described above. This is generally provided by speech pathologists or occupational therapists, but may include other practitioners.

Neuromuscular electrical stimulation (NMES), such as VitalStim®, is an approach to dysphagia management involving application of an electrical current to peripheral tissue targets. Such stimulation aims to improve function by strengthening the swallowing musculature or by stimulating the sensory pathways relevant to swallowing, or both. VitaslStim® is a specific treatment protocol that superimposes NMES upon volitional swallows.

Swallowing Disorders, also called dysphagia, are defined as any difficulty or abnormality of swallowing.

Related Procedure codes for CPT code 92526

92521 Evaluation of speech fluency (eg, stuttering, cluttering)

92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)

92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)

92524 Behavioral and qualitative analysis of voice and resonance