Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
With Great Respect,
We pay tribute to the creation of our nation’s strength, freedom and leadership….
The American Workers!!! Happy Labor Day!
Back to school time for our kids!
And …….We are closer to Fall!
DIAGNOSTEX CEU – AWESOME turnout! So great to see everyone at the conference! Thank you all for coming! Look forward to the next time! Ronda and Pam
Upcoming Holiday – DiagnosTEX will be closed on Labor Day, Monday September 7, 2014.
Please consider this when scheduling your studies. We will operate Tuesday – Friday that week.
What are we celebrating? A day off?? Yes!! But also, 148 million people 16 years and older in the nation’s labor force in June 2015. Source: U.S. Bureau of Labor Statistics
ICD 10 Effective October 1, 2015 – As most of you should know the ICD 10 will be implemented this October 1. Because this is a federal mandate, all health plans, clearinghouses, and providers using electronic transactions must transition to the ICD-10 code sets on the compliance date. Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments. This requires us and every other medical practice billing Medicare or Insurance to be diligent in obtaining all necessary information to adequately code and bill in this new coding system which is much more complex than ICD9. The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the compliance deadline of Oct. 1, 2015.To adequately bill without risking increased denials, we will have to require a copy of the History and Physical (H&P) faxed in with every referrals. This is something we have tried to encourage over the last year, as we were aware of the upcoming requirements. Therefore, as of October 1, if we do not receive a copy of the H & P with the paperwork we will not be able to schedule the study, as this information is critical for our billing and adequate coding. Sometimes on our HX consult forms the only diagnosis we get provided is HTN or DMII, and this is not a diagnosis we can use to bill for an evaluation of dysphagia. We apologize for the increased paperwork, but it is getting harder and harder to get reimbursed for the services we provide without having access to the patients chart where most of the care is given. We need your help to get that medical chart information to us so we are able to be paid for the services we are providing your patient.
Parkinson’s Voice Project – SING OUT! A Voice Revolution – Saturday September 12, 2015 in Richardson, TX. It is the Parkinson’s Voice Project 10th Anniversary. Sing out with the Loud Crowd and The Happy Days stars Anson Williams and Don Most! Enjoy 50’s music, 1950’s classic cars as well as photos with the star afterwards. For reservations – 469-375-6500 or visit www.ParkinsonsVoiceProject.org
Dates to remember in September:
National Grandparent’s Day – www.grandparents-day.com
National Women’s Health and Fitness Day – www.fitnessday.com
National Assisted Living Week – www.nalw.org
National Rehabilitation Awareness Week – www.nraf-rehabnet.org
Healthy Aging Month – www.healthyaging.net
Alzheimer’s Memory Walk (September-November) – www.alz.org I will be walking this October in Grapevine! If anyone would like to donate to my walk, I would appreciate your support to help to end this terrible disease, as we all are up close and personal with this professionally and some of us personally. Please go to the website www.alz.org and donate to my team “Heels of Hope”. Thank you!
CEU Opportunities in September
A New NFOSD webinar – September 14 at 7pm. The Most Common Causes of Solid Food Dysphagia, go to www.swallowingdisorderfoundation.com to register.
AMPCARE E-Stim course – September 25th Shreveport, LA. Go to www.ampcarellc.com to register.
Talk Tools – A friend of mine, Jennifer Jones PhD CCC-SLP, BCS–S, from Georgia is presenting this month on September 25-26 in Dallas, TX at the Double Tree on Adult and Pediatric Dysphagia. For more information go to www.talktools.com and courses.
Dysphagia Tidbit – Bedside Swallow Evaluation – How accurate are bedside evaluations? Logemann et al concluded that even if screening procedures become 100% accurate in defining the presence of aspiration or the presence of problems in the oral stage of the swallow, the pharyngeal triggering, or the pharyngeal stage of the swallow, in-depth diagnosis is still needed to define the anatomic and/physiologic nature of the problem and the effects of treatment strategies….” ? McCullough et al (2000) found fewer than 50% of the measures clinicians typically employ are rated with sufficient inter and intra-judge reliability. The efficacy of the MBS with head and neck cancer patients assessed by MBS (vs. bedside) when planning treatment ultimately had better swallow times and more efficient swallows (Logemann et al 1992).Screening does not identify the nature of the problem, the bedside exam can identify the nature of the oral dysphagia”. Screening identifies who is at risk for significant dysphagia. We’re getting better at screening and BSE, but even predicting who will aspirate does not tell us why. Rosenbek indicates screening is presymptomatic testing with aim of early diagnosis. If the patient has certain signs, symptoms, history what is the increased likelihood of dysphagia or aspiration? The risk ratio example identified variables (Logemann, et al1999) that were able to classify patients correctly as having or not having:
- Aspiration 71%
- Oral stage disorder 69%
- Pharyngeal delay 72%
- Pharyngeal problem 70%
A few things you cannot see at bedside 1) Osteophytes, 2) Retention, 3) obstruction, 4) Zenker’s diverticulum, 5) silent aspiration. We have seen many therapist provide 4 weeks of laryngeal elevation exercises for dysphagia treatment only find out the large C5-C6 osteophyte is directing the bolus into the airway on all swallows, or the Zenker’s diverticulum is refluxing on all repeat swallows. A good BSE tells you there is a pharyngeal problem, but will not identify the cause or direct your treatment.