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.
- The resident is too debilitated, nervous, or anxious to be out of the facility for 3-4 hours.
- Behavior issues or size restrictions could cause the exam to be canceled at the hospital.
- The patient is tracheostomy and/or ventilator dependent
- Staff members are required to accompany the resident to the hospital.
- The resident is unable to stand or move into the fluoroscopy unit.
- Size/frailty will negatively affect the hospital's ability to evaluate.
- The resident is wheelchair or geri chair bound.
- The facility or resident is responsible to pay the transportation cost.
- The SNF SLP needs to attend the evaluation.
- The SNF SLP needs to consult with the evaluating SLP about strategies and treatment options before/during/after the exam.
- It is important to test unusual strategies (upright vs. reclined position, Passy-Muir Valve on and off, etc.)
- Screening of the esophagus in the AP position is desired due to concerns about vocal fold function or potential esophageal issues.
- The test results/information is needed in a timely manner.
- Delay in scheduling.
- It is important for family member(s) to attend.
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
438.82 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
783.3 Feeding difficulties and mismanagement
784.49 Other voice and resonance disorders
784.52 Fluency disorder in conditions classified elseware
784.59 Other speech disturbance
784.99 Other symptoms involving head and neck
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
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