June 2013 Newsletter


June 2013

Summer is here!


Happy Father’s Day!


Do not forget to fly your American flag on the 14th in honor of our country, our troops and our freedom!

                        Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP



CMS Dining Guidelines – Apparently this has gotten a lot of attention from Administrators.  Many concerns have come up regarding CMS not paying for treatment with modified diets, or there can be no more modified diets etc.  Many have come up with their own interpretation of this document.  After contacting ASHA and some others regard this topic, I wanted to help clarify some of the information for everyone.  CMS circulated a position statement from a consortium on Dining Standards.  It does not represent CMS policy. ASHA was invited to participate in the 2010 project/information symposium and stakeholders meetings.  ASHA provided significant comment to the draft.  ASHA was not consulted or notified in advance about the CMS memorandum or the linked surveyor training video. ASHA contacted CMS to express concerns.  The draft is currently being reviewed by SIGs 13 and 15 through ASHA, for additional input.  ASHA is also in the process of scheduling a meeting with CMS to discuss any concerns. The New Dining Standards are not CMS requirements.  The memorandum does not prescribe or imply any changes in the role of an SLP with respect to evaluating or treating dysphagia. Your documentation should reflect the family and pts have been counseled on diet modifications and are in agreement with recommendations.  Hang in there; I do not see any of this becoming an issue once ASHA is represented in the development of this.



Needing a post CVA subject for  Texas Christian University Case Study Series

The purpose of this case study is to investigate the effects of a novel FDA-cleared neuromuscular electrical stimulation (NMES) program in patients presenting with persistent dysphagia.

Inclusion criteria:

  • An adult with a diagnosis of CVA and persistent dysphagia with G-Tube placement for 6 months up to 1 year (to eliminate spontaneous recovery)
  • Alert, orientated, able to follow commands and respond to yes and no questions
  • Able to provide their own transportation to the Miller Speech and Hearing Building on the TCU campus 5 days a week, Monday-Friday for 4 weeks to receive a 30 minute treatment (additional 5-10 minutes for set up and removal time)
  • Will need to provide their last modified barium swallow study to confirm that decreased laryngeal elevation is a key feature of their dysphagia
  • Participants will need to be interviewed and fill out questionnaire


Exclusion criteria:

  • Adults who have an implanted electronic device e.g. Pacemaker/defibrillator
  • Adults presenting with moderate/severe receptive aphasia and/or cognitive impairment
  • Patients presenting with progressive diseases e.g. ALS, Parkinson’s
  • Patients who are pregnant
  • Patients who have active cancerous lesions or infections which were present in the head or neck


If you have a patient interested in participating in this study, please call Rick McAdoo or Russ Campbell at 682-561-2444. There will be no cost for the dysphagia treatment provided to this individual.


Home Health fees and outpatient MBSS at a hospital vs. mobile – Just wanted to provide you with some of the feedback we have been getting from Home Health agencies.  Many  have been upset over our 2013 implemented travel fee of $25.00, therefore many have opted to send the patient to the hospital, but have found out quickly that because HH falls under consolidated billing just as LTC facilities do, the hospital will be billing the HH company for the entire bill for the MBS. CMS is clear in their regulations that the 92611 (ST code for MBSS) falls under consolidated billing as a speech service and this applies to SNF and HH. Nevertheless, the mobile unit is the least expensive way to go and will get scheduled in a more timely manner.  If you have any further questions, please call and speak to our billing office.


Allergic to…… or Gluten Free etc.

If a patient is allergic to a certain food or type of food, please supply what is appropriate for them to eat, as we do not provide options such as gluten free foods or other varieties on the van.  We supply and stock our standard protocol of applesauce, pudding, mixed fruit, cookies, and various consistencies of barium.


G-Codes/NOMS Levels for Swallowing on MBSS report

I have had some people calling asking for the definitions of the G-code ratings on our reports. These are specific to swallowing only and can be found on the ASHA website as they correspond with the NOMS level.. We provide all three because we provide an evaluation and it is also a one-time visit for us.  We are required to provide this information as well on Med B.


DiagnosTEX QA Results on 684 patients

  • Method of Nutrition Recommended =
    • PO = 528
    • NPO =156
    • Discharge Rate after MBSS  = 60%
    • Documented Silent Aspiration = 30%
    • Decrease in Alternate means of feeding (NPO to PO) = 66%
    • Esophageal disorders identified = 47%
    • Strategies implemented  during PO = 43%