February 2011 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
February 2011
Happy Valentine’s Day!

DiagnosTEX is now on Facebook!

Please use our new history/consult request form for 2011 when filling out your paperwork and scheduling your patient. You can download this form from our website.

TSHA is coming to Houston, Texas and DRS is coming to San Antonio next month! Numerous and exciting educational opportunities in our home state!
Updated DiagnosTEX service contracts – Due to new Medicare changes and increasing gas prices, we are increasing our rates… but ONLY $10.00 for the MBSS this coming year. The rate includes all of the radiology technical codes for the MBSS, which is a contracted rate between the service provider and the facility. This contractual agreement can be less or more than the actual sum of the technical codes billed, and this rate is about 75% less than the allowable. The service agreement updates would have been sent to the facility in January. If you have any questions about billing at anytime, feel free to contact us at 817-514-6271.

2011 Medicare Fees – Once again the 92611 has decreased in reimbursement levels from $125.02 to $113.87 (Dallas) and $122.83 to $112.21 (Fort Worth). We would like you to help us encourage ASHA to advocate this service with more value.

Therapy Cap – The extension of exceptions process for outpatient therapy caps with the KX modifier will continue for services on or after January 1, 2011 through December 21, 2011. All patients begin a new cap on January 1, 2011. Physical therapy and speech pathology services combined, limit incurred expenses at $1870 for 2011 (vs. $1860 in 2010). Deductable and coinsurance amounts applied to the therapy services count towards the amount accrued before the cap is reached. Every year since 2006, Congress has authorized the exception process.

MPPR – Lawmakers instituted a multiple procedure payment reduction (MPPR) policy which reduces payment for second and subsequent speech pathology, occupational therapy, and physical therapy procedures furnished to the same patient on the same day. The MPPR applies to eight speech pathology procedures, including the bedside dysphagia evaluation. This is a huge impact on therapy for patients. The MBSS is not included in the MPPR policy and will not be considered part of the multiple procedures in a day.
Question – Kinesio Taping for treatment of dysphagia – I was asked by an SLP to implement this technique under fluoro, and did so. We have used several different types of tapes with E-stim. The Kinesio tape is more elastic (allowing more “give” in movement) and does not hold positioning as well. We watched it under fluoro, noting when you are taking up “slack” of the skin on the neck you get some elevation of the hyoid bone, but not the larynx (especially when you manually move the tape up and down). The position is not maintained for long when the tape is attached to the skin around the jaw line. The hyoid bone seems to relax back to its resting position. We never saw laryngeal elevation. Elevation requires muscle contraction of the suprahyoids, and tape does not create a muscle contraction like E-stim does.

Home Health visits for an MBSS – There are certain qualifications for home health patients, part of which includes a definition of being “homebound.” Patients are considered homebound if absences from the home are infrequent, require considerable taxing effort, are of short duration and are attributed to the need of: 1) medical care, 2) religious services, 3) beauty shop appointments, 4) a brief walk around the block, 5) a drive, 6) attending adult day care. Mobile MBSS is a great service for HH, but scheduling can become difficult with the family and patient at times. DiagnosTEX will try to schedule a HH request 3 times, but it often appears that these home health patients are often not “homebound” by definition. If your home health patient is making frequent trips outside the home and is not available to be flexible with a home visit, I would encourage them to schedule at an outpatient facility that would service their time and days requirements better. We will notify the requesting SLP after an attempt to schedule has been made 3 times.

CEU OPPORTUNITY with Dr. Daniel R. Boone: 5 hours
Texas Voice Project for Parkinson Disease is pleased to announce that Dr. Daniel R. Boone will be coming to Dallas on February 19th to conduct a Voice Therapy Workshop. This is an incredible opportunity for all speech-language pathologists and graduate students. Dr. Boone has been treating patients for over 55 years. He is the author of fifteen professional books, several book chapters and monographs, and over 100 refereed journal publications. Boone is best known for his love of his students and turning them on to the excitement of clinical speech pathology practice. This workshop is being offered in conjunction with UT Dallas Callier Center for Communication Disorders. Visit or click on this link for more information and to register: http://www.texasvoiceproject.org/voicetherapyworkshop.htm

Dysphagia Tidbits – Ideas and facts to think about!
1. Use pre-thickened water, such as Aqua Care or Simply Thick to make ice cubes.
2. Drink water/liquids before meds to increase oral moisture.
3. It takes 36-72 hours after NPO for disuse atrophy of muscles (the PES in particular).
4. Coffee with a lid on it will be thicker over time than one without a lid, due to increased heat.
5. It takes 7-8 minutes for the carbonation in an open beverage to decrease and lose its effectiveness.
6. A serving of grits has only 90 “empty” calories. Add cheese, etc. to increase calorie intake.
7. GERD increases at the age of 40 years old.