Q & As for SLPs
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(Click questions below to jump to text)
As a speech-language pathologist (SLP) myself, I’ve spent countless hours and traveled around the country studying and working with swallowing disorders. But despite all this, I found that even my best detective skills for identifying aspiration were lacking. Unfortunately, I’m not alone, every SLP working with dysphagia is in the same boat. Consider these facts from the recent research:
“ On clinical investigation, dysphagia was misjudged for the majority of patients.”
“In only 33.1% of the patients, appropriate oral diet was chosen prior to FEES” and
“FEES might help to compensate for this drawback, revising the diet regime in nearly 70% of the patients.”
“most screening tests for dysphagia cannot detect silent aspiration, using FEES might help in identifying patient at risk with this safe and fast bedside assessment tool.”
(Want to read it for yourself? This study is an open-source research document that can be found at https://bmjopen.bmj.com/content/8/3/e019016)
I knew I didn’t want to continue to be “in the dark” when assessing and treating my patients with swallowing problems. But then I saw a light at the end of the endoscope! (Literally, there is a light there.) With my mobile FEES unit, I’m able to provide high quality images in real time to see exactly what is happening during the swallow, right at the patient’s bedside.
Now I can assess specific foods (even pills), watch performance during full meals, and figure out which swallowing strategies work the best!
Before I started doing FEES, I cringe to think how often I’ve kept patients on overly-restrictive diets just because I wanted to err on the side of caution. Or how often I’ve wondered if that sip of juice is silently sliding down my patient’s trachea? It’s such a peace of mind to know exactly what’s going on!
If this sounds like you, and you haven’t already scheduled a FEES for your patient to see their swallow in action, schedule a FEES now, and together we can take a look! I may be holding the endoscope, but you, as your patient’s therapist, are the key to helping them manage their swallowing impairment. Let me help you help them, by giving you the information to make confident clinical decisions regarding their treatment. Without you, I’m nothing, but together, we can make a big difference!
They are most often done following your initial clinical swallow evaluation, but doesn’t have to be! Sometimes you might want to have a FEES done before you do a full-blown swallowing evaluation: Maybe there’s a resident that has recurrent pneumonia, and you’ve been contacted to rule out silent aspiration. If the FEES exam shows no swallowing deficits, you may want to just do an evaluation only, and not plan any treatment visits. The FEES billing code (CPT 92612) can be used as the initial assessment/SOC date for a speech patient, and you may choose this to be an “evaluation only” encounter.
You, as the professional, will have to make the ultimate decision what is best for your patient as there is much to consider: medical fragility, transportation, behaviors/compliance, etc. Susan Langmore, who we know to be an authority on dysphagia and an instrumental swallow guru, developed this table to help SLPs make this decision:
Langmore, S. (2006). GI Motility Online, May 2006, doi:10.1038/gimo28
A basic FEES exam using only a few swallows of the traditional consistencies (thin liquid, applesauce, and cracker) will take approximately 20 minutes from setup to cleanup. The total time the endoscope is placed with a basic procedure is generally less than 5 minutes. If the patient is tolerating the procedure well, there are no time restrictions: you may be interested in assessing mealtime fatigue, “real” food textures (meats, breads, etc.), or variations of the compensatory strategies. I’m happy to take the extra time and help you assess all the swallowing possibilities!
No, certainly not. With the high-definition video and detailed report, you will have plenty of information to make confident clinical decisions for your patients. However, you know your patient the best, and there may be a specific food or strategies you’d like to try that you haven’t thought of until that moment. When you’re there first hand, you have the option to be in the “driver’s seat” and tell me what you’d like to do or try with the scope in place. There’s nothing like being there in person, but it’s certainly not necessary.
Yes, you can! If you are participating in the exam, you can bill this time under the dysphagia treatment code (CPT 92526). Your participation in the FEES exam is highly valued. If you haven’t already, please read the above question Do I (the SLP) need to be present during the evaluation?
Contact me to set up a time to meet with you and your therapy or facility managers. I’m happy to provide a demonstration and talk with the office staff and therapy director about the billing procedures– I’ll even bring treats! Once we’ve paved the way, you simply need to call or use the online scheduler to make appointments for your patients. Easy as pie! (Please have, or plan on getting, a physician’s order as this is required for each patient before we can do FEES.)
Yes, you can! You can call me anytime. If I’m doing a FEES exam, I may not answer, just leave a message and I will be happy to call you back as soon as I can. I’m not a national company with lots of employees. You can plan on getting personal service from me, a native Minnesota-nice “farm-girl.”