Newsletter :: April 2004


Back by Popular Demand

We will be bringing Teresa Biber back to DFW in May.  For those of you who missed out the 1st and 2nd time.  Here is another chance.  There are so many on a waiting list/cancellation list the first conference is already near capacity.  We are so excited about the success stories we are hearing out in the field with those of you who attended in February that are applying your new knowledge to their patients.  DiagnosTEX feels honored to be a part of this as we repeat MBSS on those success stories!  Also be looking for upcoming conference on Controversy’s in Dysphagia in the Fall. I began providing local DFW conferences for SLP’s with ProgressivEdge back in 1997, I look forward to continuing the same quality of conferences and material on a regular basis at low cost to you.


Response to ASHA leader Article on Electrical Stim Aids Dysphagia.

I responded promptly to this article by email to the authors as well as a letter to the editor

I am always excited to hear about the new advances in dysphagia treatment.

I completed NMES-dysphagia research which was published back in 1997-1998.  I had to respond to the article on Electrical Stimulation Aids Dysphagia, March 16, 2004  The article referenced Freed et al., 2001 article regarding E-stim over the surface of the skin not shown to elicit movement. This may apply to Freed et al., protocol and Freed et al., placement of electrodes, but there are other protocols that have and are showing success using appropriate placement of NMES.  Our protocol/placement of the electrodes in our research study DID elicit movement to control laryngeal elevation and this was proven by measurements taken on the Computerized Laryngeal Analyzer (CLA). The CLA measures the biomechanical movement of the anatomical structures associated with swallowing and automatically calculates and displays the duration of laryngeal motion.  The CLA transducer was placed on the thyroid cartilage. Two NMES electrodes were placed over the region of each belly of the anterior digastric and mylohyoid muscles.  With our parameters and protocol, movement of the larynx was displayed on the CLA at the initiation of the stimulation.  During the stimulation, the pharynx was held in position. At stimulation release it returned from its elevated position.  It is significant that the sustained elevation was achieved by stimulation only. This process was also used during videofluoroscopy to support laryngeal elevation.  E-stim can promote laryngeal elevation. Freed et al. is not the only NMES research completed on this subject and using that as the only reference is misleading to the scientific community. If you would like a copy of an E-stim proposal for your facility, give us a call and we will fax you one.

DiagnosTEX – – Yes, we operate on Fridays!  We have all of our vans committed to DFW 5 days a week! We will be there to do your MBSS in 24 to 48 hours!


Quality Assurance (QA)-  DiagnosTEX completes QA and follow-up on all the patients we evaluate. In the month of February, out of 142 patients, DiagnosTEX recommended NPO for only 13 patients and we also eliminated 76% of the patients off their NPO/TF status.  That is exciting! DiagnosTEX completes a detailed exam utilizing strategies and assessing all consistencies appropriately to provide you all of the MBSS information you need to treat your patient effectively.


Physicians orders, HMO’s,  Private insurance – DiagnosTEX will bill any insurance company for the MBSS, but the facility is responsible for obtaining the preauthorization number for the patient, as the facility has all of the medical information in it’s possession. For all orders, we request that the physician order state:  Dysphagia Consultation-Modified Barium Swallow Study. Thank you for your help!


Have any Billing questions??

There are still many questions as well as many misunderstood information about the 92611 code and consolidated billing, as well as fee schedules.  Never hesitate to call and talk to Diana about any of your billing questions.  We are here to help!


The American Stroke Association

The stroke Connection Magazine has a wealth of information for those recovering from a stroke.  You can try it free for 1 year! 1-888-4-STROKE.


New Guideline for Feeding Assistants in LTC

In March 2002, CMS proposed a rule to allow Medicare and Medicaid program to use paid feeding assistants.  They received over 6000 public comments.  Over 90% were in support of this, but many questions and concerns were raised as well as numerous suggestions for clarification and revisions of the regulation.  The federal guidelines dictate a minimum of 8 hours of training in eight specific areas: feeding techniques, assistance with feeding and hydration, Communication and interpersonal skills, appropriate responses to resident behavior, safety, and emergency procedures, infection control, resident rights, recognition of changes in residents that are inconsistent with their normal behavior, ands the importance of reporting those changes to the supervisory nurse.  Janet Brown M.S. CCC-SLP, director of Health Care Services in Speech Language Pathology says that ASHA has recommended that Speech Pathologists be identified as a resource to the supervisors of the feeding assistants and to participate is designing state approved training courses.  The final rule mentioned this suggestion, stating, “We have no objection to this, and facilities may use this approach if they choose” Federal Registry, September 26, 2003. But this did not change any of the wording of the rule to reflect ASHA’s comments.  The national no profit consumer advocacy organization for nursing home resident favors more extensive training for certified nursing assistant and registered nurses.  ASHA does not plan to take further action on the rule unless members express concern about how it is being implemented.  ASHA urges clinicians to find out if feeding assistants are being used in their buildings and offer to consult on their training, and also monitor whether their referrals for dysphagia change as a result of having feeding assistants.  Keep ASHA informed.

Banotai, A., New Guidelines for Feeding Assistance in Long-Term Care, Speech-language pathologists have a role in training, ADVANCE, March 8, 2004.