Newsletter :: March 2006


Monthly Motivator

Each new season grows from the leftovers of the past. That is the essence of change, and change is the essence of life.


Upcoming Conferences First, I would like to thank all of you who attended the NPO conference last month, it was a success, your verbal and written comments were so wonderful. I really enjoyed spending the day with you all!

TSHA 2006 Annual Convention – 50th Anniversary, March 23-25, 2006, Grapevine Texas

We are so excited to announce that Deciphering Dysphagia with E-Stim has been selected to be presented at the 2006 TSHA Annual Convention at the Gaylord Texan in Grapevine, Texas! We have been scheduled on Saturday March 25, 2006 from 1:30-3:30 in the Austin Room! DiagnosTEX will also have a booth in the exhibit hall! Stop by and see us!

April 2006 Conference – Deciphering Dysphagia with E-Stim in Austin, TX

We have been invited to present in Austin in late April. Specifics will be included in the next newsletter.

DiagnosTEX FREE Educational Conference – Understanding billing of Dysphagia and the 92611. Lots of new changes in Medicare recently. If you have questions on how to bill for dysphagia services, this is a must attend conference. Guest speaker – Medicare Rep. Please invite your DOR, Billing Dept, & Administrators. Meal will be provided. Be looking for details


DiagnosTEX and Secure Horizons

We want to reiterate that DiagnosTEX IS and HAVE BEEN a provider for Secure Horizons/PacifiCare. DiagnosTEX can provide and always has been able to provide Modified Barium Swallow Studies to all private insurance, HMO including Secure Horizons and PacifiCare at absolutely NO COST to the facility. DiagnosTEX is a provider for Blue Cross Blue Shields of Texas, PacifiCare PPO and Secure Horizons HMO. You do not have to send your patients to the hospital for Secure Horizons or to another local Mobile MBSS provider. DiagnosTEX can service all of these patients. Some facilities have told us that they received a letter from Secure Horizons that they must send them to the hospital. When we contacted Secure Horizons they are unaware of any letter. Please contact DiagnosTEX billing department if you have any concerns or questions regarding scheduling your Secure Horizons patients!


Winter Laryngitis

Laryngitis is inflammation of the VF due to infection, overuse or irritation. When the VF are inflamed they do not vibrate smoothly and result in a hoarse, strained or barely audible voice. The most common cause is upper respiratory infection. Other causes may be laryngopharyngeal reflux (LPR). Those with LPR do not have symptoms of reflux. Water is very helpful, but avoid mentholated cough drops as this irritates the VF. Limit alcohol and caffeine intake and avoid throat clearing. Professional voice users such as singers or lawyer, steroids may be warranted.

Changes = 92611 MBSS code vs. Cap – This is such a blessing to our patients and our field!

On February 13, 2006 CMS issued implementation instructions to its contractors outlining the congressional mandated exceptions process. Automatic exemption includes 92610 and 92611 if the following complex situations include:

  • The patient is d/c from a hospital or SNF within 30 treatment days of starting the episode of OP therapy
  • The patient has, in addition to another disease or condition being treatment, generalized musculoskeletal conditions or conditions affecting multiple sites not listed as automatically exempt by condition that will directly and significantly impact the rate of recovery
  • The patient has a mental or cognitive disorder in addition to the condition being treated that will directly and significantly impact the rate of recovery
  • The patient requires PT and ST services concurrently.
  • The patient had a prior episode of OP therapy during the calendar year for a different condition
  • The patient does not have access to the OP hospital therapy, including residents of the SNF that is subject to consolidated billing.

Also President Bush signed the Deficit Reduction Act of 2005 (DRA) into law on Wednesday, February 5. The DRA freezes Medicare reimbursement rates for 2006 at the 2005 levels, avoiding the 4.4% cut mandated by the sustainable growth rate formula (SGR). The SGR is used to determine the annual Medicare conversion factor update. CMS has stated that they will retroactively apply the 2005 rates to all services delivered since January 1, 2006. For more information, please contact ASHA‚s Health Care Economics Team at


FYI – If you have attended any of the E-Stim conferences we have sponsored and using these protocols for treatment of dysphagia, please confirm the dysphagia is a laryngeal elevation problem before in initiating E-Stim. We have seen many patients lately that had been receiving E-Stim for weeks without an MBSS or an MBSS with little detail and the results indicated the treatment was inappropriate due to cervical spine abnormalities, oral phase deficits, in summary….no laryngeal elevation problems. Just make sure you are not wasting your time or the patient’s time and money for a treatment/protocol focused to increase laryngeal elevation.


Dysphagia Tidbit – Progressive Supranuclear Palsy (PSP) vs. Parkinson’s Disease (PD)

PSP is a neurodegenerative syndrome and an atypical Parkinson’s disorder, also known as Steele-Richardson-Olszewski syndrome and nuchal Dystonia dementia syndrome. It is often confused with or misdiagnosed as PD. PSP is also often referred to as Parkinson’s Plus Syndrome. Most PSP patients present with dysphagia. They appear as early as age 40 but onset typically occurs in late 50-60’s and men are usually more affected than woman. Most present with a visual disturbance and feeding swallowing problems can arise simply form the inability to gaze downward in order to see the food. Those with PSP may also lose control of their swallowing mechanism. Due to body stiffness and tremors, the patients are poor self feeders and require meal monitoring. Dysphagia issues, such as aspiration usually are the cause of death. Researchers at The Department of Speech and Hearing at George Washington University in Washington DC focuses on the differences of swallowing difficulties with PSP and PD. The researches conducted an MBSS to look at the dysphagia components of PSP and compared them to PD, and also provided a swallowing questionnaire. The research indicated that PSP are much more aware of their dysphagia and symptoms than those with PD. Eight-five percent of the patients with PSP had oral phase deficits on the MBSS as well as pharyngeal deficits as most of the oral deficits related to some of the pharyngeal problems. Thin liquids were a significant challenge to the PSP population, causing chest infections. Though every case was treated individually, most patients required a diet of puree or smoother texture. Strategies included proper positioning and sitting upright during meals, eliminating distraction, slow feeding rate, and keeping food in line of vision.


New Educational NPO handout for Patients and Families – Ask for yours next time we see you!