How To Use CPT Code 74230

CPT 74230 is a radiologic examination code for swallowing function with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 74230.

1. What is CPT 74230?

CPT 74230 is a medical billing code used to describe a specific type of radiologic examination that focuses on the patient’s swallowing function. This examination involves the use of cineradiography or videoradiography, along with contrast material such as barium, to visualize and assess the patient’s swallowing pattern. The code is used by medical coders and billers to accurately document and bill for this procedure.

2. 74230 CPT code description

The official description of CPT code 74230 is: “Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study.”

3. Procedure

1. The patient is positioned in an upright position.
2. Scout neck films may be taken before the patient ingests the barium meal.
3. The patient is provided with food and drink of different amounts and consistencies mixed with barium.
4. The provider observes the swallowing pattern by monitoring the motion of food, mobility of the tongue, and the muscular contractions of the oropharynx, hypopharynx, and upper esophagus in real-time under fluoroscopic or other imaging guidance.
5. The images are recorded with cineradiography/videoradiography for further evaluation.
6. Based on initial findings, additional delayed films may be taken hours after the initial imaging.
7. The provider analyzes the images and prepares a report.

4. Qualifying circumstances

Patients who are experiencing difficulty swallowing, have a history of aspiration, or present with other swallowing-related symptoms may be eligible to receive CPT code 74230 services. This examination can help identify structural or functional abnormalities in the patient’s swallowing mechanism, which can aid in the diagnosis and treatment of various swallowing disorders.

5. When to use CPT code 74230

It is appropriate to bill the 74230 CPT code when a provider performs a radiologic examination of the patient’s swallowing function using cineradiography or videoradiography, along with contrast material such as barium. This code should be used when the examination includes scout neck radiograph(s) and delayed image(s), if performed.

6. Documentation requirements

To support a claim for CPT 74230, the following information should be documented in the patient’s medical record:

• Indication for the examination (e.g., difficulty swallowing, history of aspiration, etc.)
• Details of the procedure, including the use of cineradiography or videoradiography, contrast material, and any scout neck radiograph(s) or delayed image(s) taken
• Findings from the examination, including any abnormalities observed in the swallowing mechanism
• Interpretation and analysis of the images by the provider
• A written report of the examination findings and any recommendations for further evaluation or treatment

7. Billing guidelines

When billing for CPT code 74230, it is important to follow the appropriate guidelines and rules. If the physician’s interpretation of the radiology service is being reported, professional component modifier 26 should be appended to the radiology code. If only the technical component of the radiology service is being reported, modifier TC should be appended to the radiology code. However, payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical. Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 74230 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes in its descriptor over the years, with the most recent change occurring on January 1, 2020.

9. Similar codes to CPT 74230

There are several other codes related to radiologic examinations of the swallowing function. Some of these codes and how they differ from CPT 74230 are:

1. CPT 92611: This code is used for otorhinolaryngologic services fluoroscopic evaluation of swallowing function, which is a different type of examination than CPT 74230.
2. CPT 74220: This code is for a radiologic examination of the esophagus, which focuses on the esophagus rather than the entire swallowing function.
3. CPT 74240: This code is for a radiologic examination of the upper gastrointestinal tract, which includes a broader scope of examination than CPT 74230.
4. CPT 74241: This code is for a radiologic examination of the upper gastrointestinal tract with small intestine follow-through, which is a more extensive examination than CPT 74230.
5. CPT 74245: This code is for a radiologic examination of the gastrointestinal tract, which includes an even broader scope of examination than CPT 74230.

10. Examples

Here are 10 detailed examples of CPT code 74230 procedures:

1. A patient with a history of aspiration pneumonia undergoes a CPT 74230 examination to assess their swallowing function and identify any abnormalities.
2. A patient with a recent stroke and difficulty swallowing has a CPT 74230 examination to evaluate their swallowing mechanism and determine the need for further intervention.
3. A patient with a known esophageal stricture undergoes a CPT 74230 examination to assess the impact of the stricture on their swallowing function.
4. A patient with a suspected Zenker’s diverticulum has a CPT 74230 examination to confirm the diagnosis and evaluate the severity of the condition.
5. A patient with dysphagia due to Parkinson’s disease undergoes a CPT 74230 examination to assess their swallowing function and determine the need for modifications to their diet or swallowing therapy.
6. A patient with a history of head and neck cancer has a CPT 74230 examination to evaluate their swallowing function following radiation therapy.
7. A patient with a suspected cricopharyngeal spasm undergoes a CPT 74230 examination to confirm the diagnosis and assess the severity of the condition.
8. A patient with a known esophageal motility disorder has a CPT 74230 examination to evaluate the impact of the disorder on their swallowing function.
9. A patient with a suspected laryngeal cleft undergoes a CPT 74230 examination to confirm the diagnosis and assess the severity of the condition.
10. A patient with a history of esophageal surgery has a CPT 74230 examination to evaluate their swallowing function and determine the need for further intervention or therapy.