How To Use CPT Code 92526

CPT 92526 refers to the treatment of swallowing dysfunction and/or oral function for feeding, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 92526?

CPT 92526 is a medical billing code used to describe the treatment of swallowing dysfunction and/or oral function for feeding. This code is utilized by healthcare providers to bill for services related to the diagnosis and treatment of patients experiencing difficulties with swallowing or oral function during feeding.

2. 92526 CPT code description

The official description of CPT code 92526 is: “Treatment of swallowing dysfunction and/or oral function for feeding.”

3. Procedure

The 92526 procedure involves the following steps:

1. Evaluation of the patient’s swallowing and oral function, including a thorough medical history and physical examination.
2. Identification of the underlying cause of the dysfunction, which may include neurological, structural, or functional issues.
3. Development of a treatment plan tailored to the patient’s specific needs and the identified cause of the dysfunction.
4. Implementation of the treatment plan, which may include medications, rehabilitation, or the use of a feeding tube.
5. Monitoring of the patient’s progress and adjustment of the treatment plan as needed.
6. Continued follow-up and evaluation to ensure the patient’s swallowing and oral function improve over time.

4. Qualifying circumstances

Patients eligible to receive CPT code 92526 services include those who:

• Experience difficulty swallowing or have impaired oral function during feeding.
• Have a medical condition or injury that affects their ability to swallow or maintain proper oral function.
• Require intervention to improve their swallowing function and/or oral function for feeding.
• Have not responded to conservative treatments or require specialized care for their swallowing dysfunction.

5. When to use CPT code 92526

It is appropriate to bill the 92526 CPT code when a healthcare provider performs a treatment specifically targeting a patient’s swallowing dysfunction and/or oral function for feeding. This may include cases where the patient has a medical condition or injury that affects their ability to swallow or maintain proper oral function, and the provider has determined that intervention is necessary to improve the patient’s quality of life and overall health.

6. Documentation requirements

To support a claim for CPT 92526, healthcare providers must document the following information:

• A comprehensive medical history and physical examination, including an assessment of the patient’s swallowing and oral function.
• A clear diagnosis of the underlying cause of the swallowing dysfunction and/or oral function impairment.
• A detailed treatment plan, including the specific interventions and therapies used to address the patient’s dysfunction.
• Progress notes documenting the patient’s response to treatment and any adjustments made to the treatment plan.
• Follow-up evaluations to monitor the patient’s progress and ensure the continued effectiveness of the treatment plan.

7. Billing guidelines

When billing for CPT code 92526, healthcare providers should adhere to the following guidelines:

• Ensure that the patient meets the qualifying circumstances for receiving CPT 92526 services.
• Document all required information to support the claim, as outlined in the documentation requirements section.
• Bill only one unit of CPT 92526 per day, as it is an untimed code.
• Do not report diagnostic or treatment procedures separately if they are included as part of the evaluation and management services for the patient’s swallowing dysfunction.

8. Historical information

CPT 92526 was added to the Current Procedural Terminology system on January 1, 1996. There have been no updates to the code since its addition.

9. Similar codes to CPT 92526

Five similar codes to CPT 92526 and how they differentiate are:

• CPT 92521: This code is used for the evaluation of speech fluency, which is different from the treatment of swallowing dysfunction and/or oral function for feeding.
• CPT 92522: This code is for the evaluation of speech sound production, which focuses on the patient’s ability to produce speech sounds rather than their swallowing function.
• CPT 92523: This code covers the evaluation of speech sound production with an evaluation of language comprehension and expression, which is more comprehensive than the treatment of swallowing dysfunction.
• CPT 92524: This code is for the behavioral and qualitative analysis of voice and resonance, which is not directly related to swallowing dysfunction or oral function for feeding.
• CPT 92610: This code is for the evaluation of oral and pharyngeal swallowing function, which is a diagnostic assessment rather than a treatment like CPT 92526.

10. Examples

Here are 10 detailed examples of CPT code 92526 procedures:

1. A patient with a history of stroke experiences difficulty swallowing and requires rehabilitation to improve their swallowing function.
2. A patient with Parkinson’s disease has impaired oral function during feeding and requires medication management to address their swallowing dysfunction.
3. A patient with a traumatic brain injury requires a feeding tube to address their inability to swallow and maintain proper oral function during feeding.
4. A patient with esophageal cancer undergoes treatment to improve their swallowing function and oral function for feeding.
5. A patient with a neurological disorder experiences difficulty swallowing and requires a comprehensive treatment plan to address their dysfunction.
6. A patient with a structural abnormality in their throat undergoes surgery to improve their swallowing function and oral function for feeding.
7. A patient with a history of radiation therapy for head and neck cancer experiences difficulty swallowing and requires specialized care to address their dysfunction.
8. A patient with a degenerative neuromuscular disease requires ongoing treatment to maintain their swallowing function and oral function for feeding.
9. A patient with a congenital disorder affecting their ability to swallow undergoes treatment to improve their swallowing function and oral function for feeding.
10. A patient with a functional swallowing disorder requires a combination of medication management, rehabilitation, and ongoing monitoring to address their dysfunction and improve their oral function for feeding.