How MBS Envision Can Reduce Costs for Your Facility

A proactive dysphagia program coupled with accurate and thorough MBS evaluations mean less aspiration pneumonia, fewer PEG tubes, and less thickened liquids. 

The subsequent treatment recommended by MBS Envision can maintain a Part A stay or can be billed to Part B.

The properly done MBS evaluation addresses three things:

1.  If, when, and why aspiration is occurring

2.  The safest diet level to maintain hydration and nutrition

3.  Therapeutic goals and strategies

The hospital exam generally does not address all three.

 

When to Consider an In-House Physician-Supervised MBS Envision Study

  1. The resident is too debilitated, nervous, or anxious to be out of the facility for 3-4 hours.
  2. Behavior issues or size restrictions could cause the exam to be canceled at the hospital.
  3. The patient is tracheostomy and/or ventilator dependent
  4. Staff members are required to accompany the resident to the hospital.
  5. The resident is unable to stand or move into the fluoroscopy unit.
  6. Size/frailty will negatively affect the hospital's ability to evaluate.
  7. The resident is wheelchair or geri chair bound.
  8. The facility or resident is responsible to pay the transportation cost.
  9. The SNF SLP needs to attend the evaluation.
  10. The SNF SLP needs to consult with the evaluating SLP about strategies and treatment options before/during/after the exam.
  11. It is important to test unusual strategies (upright vs. reclined position, Passy-Muir Valve on and off, etc.)
  12. Screening of the esophagus in the AP position is desired due to concerns about vocal fold function or potential esophageal issues.
  13. The test results/information is needed in a timely manner.
  14. Delay in scheduling. 
  15. It is important for family member(s) to attend.

 

ICD-9 Codes That Support Medical Necessity for a Modified Barium Swallow Study

150.0-150.9 Malignant neoplasm of esophagus

161.0-161.9 Malignant neoplasm of larynx

162.0-162.9 Malignant neoplasm of trachea, bronchus and lung

332.0-332.1 Parkinson's disease

438.11 Aphasia

438.12 Dysphagia

438.82 Dysphagia cerebrovascular disease

464.01 Acute Laryngitis with obstruction

464.51 Supraglottitis unspecificed with obstruction

478.30-478.34 Paralysis of vocal cords or larynx

478.6 Edema of larynx

507 Pneumonitis due to inhalation of food or vomiting

530 Achalasia and cardiospasm

530.10-530.19 Diseases of esophagus

530.3 Stricture and stenosis of esophagus

530.5 Dyskinesia of esophagus

530.6 Diverticulum of esophagus, acquired

530.81 Esophageal reflux

530.85 Barrett's Esophagus

530.86 Infection of esophagostomy

530.87 Mechanical complication of esophagostomy

783.21 Abnormal loss of weight

783.22 Underweight

783.3 Feeding difficulties and mismanagement

784.49 Other voice and resonance disorders

784.51 Dysathria

784.52 Fluency disorder in conditions classified elseware

784.59 Other speech disturbance

784.99 Other symptoms involving head and neck

786.2 Cough

787.2 Dysphagia

793.1 Nonspecific (abnormal) findings on radiological and other examination of lung field

933.1 Foreign body in larynx

934.0 Foreign body in trachea

934.1 Foreign body in main bronchus

997.3 Aspiration pneumonia

V41.6 Problems with swallowing and mastication

V48.3 Mechanical and motor problems with neck and trunk

V67.1 Follow-up examination following radiotherapy

 

Requirements for the MBS Envision Service

From the Facility

  • A 9x9 room allowing privacy for the resident
  • A standard wall outlet, preferably one equipped for emergency backup power
  • A small table for setup and a trash can for waste
  • The resident's medical chart or (for those with electronic charting) a copy of the most recent history and physical, orders, current medications, and any prior Swallowing Evaluations.
  • Copy of the resident's insurance card

From the Facility Staff

  • A copy of the resident's current vital signs 
  • The resident must be seated upright in a chair, wheelchair, or similar seating device that can be used during the study. (The study cannot be completed in the resident's bed or on a gurny.) 
  • The resident's hearing aid(s) and denture(s) if applicable

 

From the SNF SLP

  • Copies of the patient's face sheet, MD order, clinical swallow evaluation, MBS Envision Consent Form, and MBS Envision Patient Information Form